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Hot Flashes Ahead

The Challenges of Menopause

Menopause is an important time of transition for every woman, but when you also have Hashimoto’s it can be particularly challenging.

I recently attended a lecture called the Neuroendocrine Immunology of Perimenopause written by Dr. Datis Kharrazian. I learned a ton and I’ll share some of it, but I must say I was disappointed by the lack of references to Hashimoto’s and hypothyroidism. Fortunately, that disappointment led me to explore these topics further with Hashimoto’s in mind.

In this post we examine the physiological changes that women go through during this time of their lives and we show how these changes can be impacted by Hashimoto’s and hypothyroidism. And, as always, we explore why it matters.

Perimenopause Isn’t a Disease

For many women in the US and in cultures that have adopted our diet and lifestyle, menopause has become something to dread. It is associated with physical, emotional and psychological decline and for some also brings with it an increased risk of numerous other conditions.

And these other conditions are not minor. They include:

Cardiovascular disease and stroke
Oesteoporosis
Dementia and Alzheimer’s disease
Arthritis
Autoimmune disease (Yes, that includes Hashimoto’s)

However, this is not true for everyone. And it is a relatively new phenomena, for much of recorded history and in many other cultures throughout the world menopause is just another transition in life.

Like the transitions from childhood to adolescence and adolescence to adulthood, the transition to menopause is just a transition. It lasts about a year and life goes on without major declines in health and well being.

Why Are Women in Western Cultures Different?

Studying menopause across cultures is difficult, but the research has shown some possible differences in different countries and ethnic groups.

For example, Japanese women may report fewer hot flashes because they have a diet high in soy (which includes phytoestrogens) (Freeman & Sherif, 2007).

Within the medical literature there are different views on the relationship between body mass index (BMI) and hot flashes, with some studies linking a protective effect of body fat, others the opposite, and some finding no connections (Andrikoula & Prevelic, 2009; Chedraui et al., 2007; Freeman et al., 2001; Schwingl et al., 1994; Whiteman et al., 2003).

However more recently, Thurston et al. (2009) have found that body fat gains during the menopause, rather than high or low BMI, were associated with hot flash symptoms.

Women who smoke and have sedentary lifestyles have been found to report more menopausal symptoms. And this makes sense when you look at what is happening physiologically which we will explore shortly.

Reproductive history may also be relevant; for example, in the Mayan culture women marry between the ages of 14 and 18 years, have many children and few repetitive menstrual cycles.

Mayan women usually enter the menopause in their early to mid 40s, which is about 10 years earlier than women in the UK and North America (Beyene, 1989).

Common Physical Changes Across Cultures

Regardless of your cultural background, there are some important changes that take place in the body during peri-menopause and menopause and these can be amplified when you also have Hashimoto’s.

Of course, everything in the body happens for a reason and is caused by specific mechanisms. For example, in a moment I’ll explore the most common perimenopausal symptoms and the mechanisms or causes that lead to them.

But before I do, I want to share an observation that is a really important mindset for making the transition to menopause far gentler and less destructive.

Treat Your Body During Perimenopause Like You Would in Pregnancy

After looking at all this research, one thing I realized is that the problems and more severe symptoms that are caused by this transition are entirely preventable if you prepare for them and take action before they happen.

And even if you have already gone through this transition, taking these preventative measures will also reduce your risk of developing some of the serious conditions we mentioned above.

Here’s a simple way to think about it: treat your body in the years leading up to perimenopause just like you would when you are pregnant. Don’t smoke, don’t drink excessive amounts of alcohol, don’t over indulge in refined sugars and junk food.

Reduce stress, get moderate amounts of exercise and heal the parts of your body that may be compromised. In particular, focus on healing your brain, your gut, your adrenals and do everything you can to reduce inflammation.

If you have read any of our other materials or my new book, Roadmap to Remission, you will notice that these are all important areas to heal when you have Hashimoto’s, as well.

Common Symptoms and their Causes During Perimenopause

Here’s an overview of the most common symptoms of perimenopause and some of their potential causes.

1. Systemic inflammation and pain: This is caused by surges in certain immune cells and proteins called cytokines. Cytokines like IL-6, IL-1 and TNF-alpha are all implicated in Hashimoto’s, as well.

2. Multiple food sensitivities, gastrointestinal symptoms. These are often caused by Intestinal permeability or “leaky gut”: This maybe caused by declines in estrogen, increases in cortisol production, hypothyroidism and dysfunction in the gut. Intestinal permeability is ground zero for autoimmunity, as well.

3.More stress, poor sleep, fatigue during the day. The adrenals have to do additional work when other female hormones, like estrogens decline. Adrenals issues are also very common with Hashimoto’s.

4. Poor circulation, cold hands and feet, poor nails beds, fungal overgrowth in nail beds. This is caused by problems with peripheral circulations, especially in the small vessels. And may be due to altered nitric oxide function. These symptoms are also very common with Hashimoto’s.

5. Brain fog, depression, memory loss and poor cognitive function. This is due to inflammation in the brain and deficiencies or declines in neurotransmitters. These are some of the most common symptoms of Hashimoto’s.

6. Hot flashes, night sweats. A hallmark of perimenopause caused by altered FSH (follicle stimulating hormone) and feedback from the ovaries. This is a less common symptom of Hashimoto’s but something many women experience.

7. Poor bone density. This is caused by problems in osteoclast or bone cell formation and other issues. It is also a very real concern for Hashimoto’s patients, as well. One of the major causes of this breakdown in bone health is the cytokines that we spoke about above.

Let’s Look a Little Deeper into these Mechanisms and What to Do About Them

Now, let’s dive a little deeper and look at what to do about each of these symptoms.

Cytokine Surges: Immune System on Fire

Hashimoto’s is, as we all know, an autoimmune disease. One of the hallmarks of autoimmunity is an overly excited immune system and this can be seen in high levels of substances called cytokines.

The root of autoimmunity and the damage it causes in the body is inflammation. many of these cytokines help promote this inflammation.

When you go through the changes of menopause, estrogen levels decline and estrogen calms inflammation. So if you already have an overexcited immune system producing lots of cytokines, you may have a major surge during peri-menopause and menopause.

Other signs of cytokines include:

1. Brain inflammation: brain fog is a clear sign
2. Body fat: adipose tissue produces cytokines
3. Free radicals: this causes inflammation
4. Stress: it’s very inflammatory

Declines in estrogen can lead to cells being more responsive to cytokines and more receptors and messengers that just amplify this inflammation. This can stay elevated even after estrogen replacement therapy.

Leaky Gut: Ground Zero

In my opinion, the breakdown of the intestinal lining that results in leaky gut and intestinal permeability is an important battlefield in healing Hashimoto’s.

Well, declines in estrogen production can lead to breakdowns in the gut, as well. When this happens you may develop leaky gut, as wells leaks in the blood brain barrier.

And these leaks cause the immune system to get all fired up and it creates more of the cytokines we just mentioned above.

It’s a classic vicious cycle made worse by estrogen levels declining.

Adrenals to the Rescue

During and after the transition of menopause the adrenal glands step in and take over for the ovaries.

Essentially, what happens is this.

FSH (Follicle Stimulating Hormone) receptors in the ovaries begin to lose sensitivity during perimenopause. This leads to changes in levels of FSH and estradiol.

The adrenals, in turn, step in and create more adrostenedione, a steroid hormone and this is converted to estrogen by adipose (fat) tissue.  It’s the body’s way of compensating for declines in estrogen.

Obviously, there is a potential problem here if the adrenals are already taxed or exhausted. A lot more demands are made on them in perimenopause.

So adrenal health is very important prior and during this transitional time.

Poor Circulation

Circulatory issues are very common with patients with Hashimoto’s. This is due to many factors including systemic inflammation, and the tendency for the body to compensate for hypothyroidism by bringing blood from the extremities into the body.

This sometimes occurs because the body is trying to regulate blood pressure and hypothyroidism, at least at first, can cause low blood pressure.

Another issue that leads to poor circulation in the extremities is lower plasma volume. This is caused by the capillaries becoming more permeable and when this happens albumin and water can leak from the vessels into the intestinal spaces.

This causes swelling from edema and water retention, often in the ankles and lower legs. Of course increased swelling is going to impact circulation, as well.

Brain Fog

I have written quite a bit about the profound impact of Hashimoto’s on the brain and it is an area that I am very passionate about. If you aren’t familiar with this, here’s a previous post on brain fog.

In a nutshell, hypothyroidism and autoimmunity can both lead to inflammation in the brain. This is caused by many things including breakdowns in the blood brain barrier, blood sugar imbalances, adrenal stress and more. In addition, as estrogen declines during menopause and peri-menopause the body loses it’s anti-inflammatory effects.

The result of all of this is a massive reaction by the brain’s immune cells, the microglia. These cells have no real off switch so once they get activated it can be difficult to calm them down. And when they are called into action they can cause more inflammation and destruction of brain cells and neurons.

All of this results in that all too familiar feeling of brain fog, difficulty concentrating, focus problems and all the associated emotional issues of isolation, depression and anxiety.

Hot Flashes

The exact mechanism for hot flashes is not known. But there are many interesting theories.

Robert R. Freedman has studied hot flashes for 25 years. He and his colleagues measured skin temperature, blood flow, and skin conductance (an electrical measure of sweating) in menopausal women before, during, and after hot flashes.

They found that women who have hot flashes have a lower tolerance for small increases in the body’s core (innermost) temperature than women who don’t have hot flashes. The body tries to keep its core temperature within a comfortable “thermoneutral zone.” When our core temperature rises above the zone’s upper threshold, we sweat; when it drops below the lower threshold, we shiver.

Women who don’t have hot flashes have a thermoneutral zone of several tenths of a degree centigrade. But in women with hot flashes, this thermoneutral zone is so narrow, it’s “virtually nonexistent,” according to Freedman.

As a result, small variations in core body temperature — by as little as one-tenth of a degree centigrade — that don’t trouble some women trigger hot flashes (and chills) in others.

What causes the thermoneutral zone to narrow? One theory is that elevated levels of the brain chemical norepinephrine are involved. Norepinephrine has been shown to reduce the thermoneutral zone in animals.

Interestingly, patients with hypothyroidism often have elevated levels of norepinephrine. One theory is that hypothyroidism can cause changes in blood flow (hemodynamics). One thing the body does to compensate for less blood flow is to release more norepinephrine. So you can see, hypothyroidism could make this symptom worse.

Poor Bone Density

Oesteoporosis is a major concern for both Hashimoto’s and menopausal women. One common factor in both is the IL-6. This cytokine is a major predictor of bone loss in women, especially in the first decade of menopause.

These pro-inflammatory immune proteins are also involved in the body’s reabsorption of bone. In addition, one of the roles of estrogen is to slow the break down of bones.

What the research seems to suggest is that the combination of increased cytokines and decreased estrogen leads to more bone loss. It’s a perfect storm of inflammation and natural transitions.

With thyroid disorders bone loss is also a major issue. Too much thyroid hormone can lead to  to increased bone mineral resorption and calcium loss through kidneys. (One reason why it’s so important to not take too much thyroid hormone.)

Also, hypothyroidism can lead to problems with the bones. It seems that there is increase in bone density in adult subjects with hypothyroidism, but the bone quality is poor which is responsible for the possible increase in fracture in these patients.

What Do You Do?

Isn’t that always the million dollar question?

Well, if you’ve read any of my writing you’ll know my answer it, “It depends.” And it does, you have to address the problems.

So, let’s review the problems and look for common issues. That will tell us what we should do.

Here are the main issues we identified:

Inflammation
Leaky gut
Stress
Poor circulation
Brain fog
Hot flashes
Bone loss

1. Inflammation:

Ok, well we identified that inflammation and pro-inflammatory cytokines are at least partly responsible for brain fog, hot flashes, bone loss and, of course systemic inflammation.

So, dealing with inflammation, the root of all evil is pretty darn important.

What can we do for inflammation?

Well, boosting Vitamin D is super important, especially because of it’s role in bone health. Other anti-inflamatories like turmeric, glutathione, resveratrol, and also avoiding foods that are pro-inflammatory like gluten, dairy and soy.

2. Declines in Estrogen:

We also noted that declines in estrogen can lead to all of the above, plus leaky gut. And there are 2 ways to deal with this. Heal and empower the adrenals to take over, or supplement with hormone replacement therapy.

Hormone replacement therapy comes with it a number of risks. Breast and ovarian cancer being top of the list.

Also, according to a study in the New England Journal of Medicine, June 7th 2001 on women treated for thyroid cancer found that about 40% of women taking thyroid hormone had decreases in their blood levels of thyroxine. These levels were low enough to trigger hypothyroid symptoms, such as low energy and feeling tired, sluggish, and cold, or to put them at risk for regrowth of thyroid cancer.

In addition, estrogen has also been linked to increased metastasis of thyroid cancer. And radioactive iodine therapy has been linked to a increased risk of breast cancer in some studies.

Some herbs that are helpful for healthy estrogen metabolism are: tribulus, panax ginseng, dang guy, black cohosh, redeliver leaf, isoflavones from soy (sometimes called phytoestrogens may also help, but must be used cautiously with Hashimoto’s patients), cruciferous vegetables can also helpful in estrogen metabolism, and vitamins that support methylation like B6, B12 and folic acid are also helpful for clearing out dangerous estrogen metabolites.

3. Leaky Gut

In my opinion, leaky gut is ground zero for autoimmunity and Hashimoto’s. It also happens to be a major factor in preimenopause. Estrogen reduces permeability of the intestines by strengthening the tight junctions of the intestinal walls.

As etsrogen levels decline, intestinal permeability risk increases. Add Hashimoto’s and hypothyroidism to the mix and you have a potent recipe for leaky gut.

To heal leaky gut avoid the foods that can make it worse: eliminate gluten, dairy and soy. Consider trying a diet like the Autoimmune Paleo diet. Drink bone broth, kombucha tea and water keifer.

4. Adrenal Health

If you elect not to do estrogen replacement therapy, then your adrenals become very important for your health and well being.

And stress management becomes absolutely essential.

For the adrenals: phosphatidylserine, adaptogenic herbs like Siberian ginseng, holy basil, rhodiala are beneficial. As is licorice root, DHEA, B vitamins, B 1 and B 2 and more.

All of these herbs and vitamins shouldn’t be taking randomly in what I like to call “the supplement lottery”. You should first do a proper assessment of each system of the body and then determine which supplements may be appropriate.

Also, having a real stress strategy and not just an abstract understanding of the destructive effects of stress is also critical. Yoga, qi gong, meditation, prayer, massage therapy, acupuncture, walking in Nature, having fun are effective for treating stress.

Any and all of these activities must become a regular part of your life. In fact, if you do anything you should err on the side of too much relaxation and stress treatment. Stress is very inflammatory, not treating it is just not an option.

I provide a detailed discussion of proper assessment in my new book, Roadmap to Remission, A Practical Guide to Hashimoto’s Healing

References:

The Neuroendocrine Immunology of Perimenopause, 2015, Dr. Datis Kharrazian

http://www.natural-menopause-journey.com/perimenopause-symptoms-and-culture.html: menopause differences in different cultures

https://thepsychologist.bps.org.uk/volume-24/edition-5/menopause

Freeman, E.W., Sammel, M.D., Grisso, J.A. et al. (2001). Hot flashes in the late reproductive years: Risk factors for African American and Caucasian women. Journal of Women’s Health & Gender-Based Medicine, 10(1), 67–76.

Freeman, E.W., Sammel, M.D., Lin, H. et al. (2005). The role of anxiety and hormonal changes in menopausal hot flashes. Menopause, 12(3), 258–266.

Freeman, E. & Sherif, K. (2007). Prevalence of hot flushes and night sweats around the world. Climacteric, 10, 197–214.

Andrikoula, M. & Prevelic, G. (2009). Menopausal hot flushes revisited. Climacteric, 12, 3–15.Avis, N.E., Crawford, S.L. & McKinley, S.M. (1997). Psychosocial behavioural and health factors related to menopause symptomatology. Womens Health, 3, 2, 103–120.

Avis, N.E., Stellato, R., Crawford, S. et al. (2001). Is there a menopausal syndrome? Menopausal status and symptoms across racial/ethnic groups. Social Science and Medicine, 52, 345–356.

Hunter, M.S., Gupta, P., Papitsch-Clark, A. & Sturdee, D.W. (2009). Mid–aged health in women from the Indian subcontinent (MAHWIS): A further quantitative and qualitative investigation of experience of menopause in UK Asian women, compared to UK Caucasian women and women living in Delhi. Climacteric, 12(1), 26–37.

Thurston, R.C., Sowers, M.F.R., Sternfeld, B. et al. (2009). Gains in body fat and vasomotor symptom reporting over the menopausal transition. The Study of Women’s Health Across the Nation. American Journal of Epidemiology, 170(6), 766–774.

Beyene, Y. (1989). From Menarche to menopause: Reproductive lives of peasant women in two cultures. Albany, NY: State University of New York Press.

Freedman, RR. Seminars in Reproductive Medicine 2005; 23 (2): 117-125.

http://www.ncbi.nlm.nih.gov/pubmed/19433574 Estrogen and Leaky gut

http://www.ncbi.nlm.nih.gov/pubmed/11844745 Changes in proinflammatory cytokine activity after menopause

http://www.ncbi.nlm.nih.gov/pubmed/9507566 Changes in enzymatic antioxidant defense system of women after menopause

http://www.ncbi.nlm.nih.gov/pubmed/11344203 IL-6 as a predictor of bone loss

http://www.ncbi.nlm.nih.gov/pubmed/6467635 : Plasma elevations of norepinephrine

http://hyper.ahajournals.org/content/5/1/112.full.pdf Hypothyroidism and hypertension

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3169869/ Thyroid disorders and Bone Loss

http://www.hindawi.com/journals/ije/2013/941568/ Estrogen and Thyroid Cancer metastasis

http://www.ncbi.nlm.nih.gov/pubmed/12182054 : Hormone Replacement therapy after thyroid surgery

Female menstrual cycle, ovulation process and hormone levels, detailed medical illustration.

Hashimoto’s Can Affect a Woman’s Cycle

Hashimoto’s affects so many different systems of the body. One of the main reasons is that thyroid hormone affects so many different activities.

One of the most complex areas of interaction is that of the thyroid and female hormones.

Having some idea of these relationships can be helpful in understanding what is happening in your body. And may help shed light on some symptoms you are having.

Also, once you understand, then you can start working on a plan to fix them.

(But fair warning, your doctor, even your endocrinologist may not understand these interactions and may have even less of idea of what to do about them.)

Understanding Feedback Loops

In the body there are 2 different kinds of feedback loops: positive feedback and negative feedback. These can both play a major role with Hashimoto’s and hypothyroidism.

And the irony is that positive feedback can result in really negative outcomes, while negative feedback generally helps to keeps things in balance which results in positive outcomes.

Positive Feedback Isn’t So Positive

Positive feedback is the feedback of repetition and reinforcement. You get something created from a behavior, habit or health issue and it keeps reinforcing itself.

Take progesterone and Hashimoto’s, for example.

If you take progesterone AND you’ve got Hashimoto’s, taking external progesterone may stimulate your thyroid gland to become more active–increase levels of TPO–and  fan the flames of that autoimmune attack on TPO.

What are the signs that progesterone is worsening the Hashimoto’s, or maybe even triggering it?

You could have more fatigue, more hair loss, more depression.  You could actually make the symptoms that you thought you were treating with the progesterone worse.

Many women go into a doctor’s office, be it a acupuncturist or a medical doctor or naturopath, complaining of symptoms like depression, hair loss, low libido…and the doctor thinks that that person has a hormonal problem such as a progesterone “deficiency” or  “estrogen dominance”.

And the well-meaning practitioner may prescribe creams or oral progesterone and then—the symptoms get worse.

If your symptoms get worse with progesterone that’s a good sign you probably DO NOT have a progesterone deficiency or estrogen dominance. 

Instead, it may have caused a flare up of Hashimoto’s. 

Adding more progesterone just added to the positive feedback loop.

This whole thing is reinforced and repeated and just builds on itself. This is how vicious cycles are born and how they continue to progress and make things worse. Adding insult to injury.

Negative Feedback Isn’t That Negative

Negative feedback is your body’s way of course correcting.

For example, with thyroid hormone, when too much thyroid hormone is produced, the body responds and signals the thyroid to stop making so much.

Neurons in the hypothalamus secrete thyroid releasing hormone (TRH), which tells cells in the anterior pituitary to secrete thyroid-stimulating hormone (TSH).

TSH binds to receptors in the thyroid gland, stimulating the making and release of thyroid hormones, which affect virtually all the cells in the body.

When blood concentrations of thyroid hormones increase above a certain threshold, TRH-secreting neurons in the hypothalamus are inhibited and stop secreting TRH.

One of the things we often see when working with Hashimoto’s people is the complex nature of feedback loops causing a web of problems.

Positive feedback or the feedback of reinforcement leads to one system breaking down and causing a domino effect in others.

The only way to alter these feedback loops is to address all the different parts simultaneously.

That way you can reverse the negative trends and create positive healing momentum.

To add another layer of complication the endocrine system has a number of negative feedback loops that help to regulate and balance other things.

For example, high levels of estrogen suppress the secretion of FSH (follicle stimulating hormone).

So there are naturally occurring positive (reinforcing) and negative (suppressing or counterbalancing) feedback loops happening all the time.

This Is Not A One Way Street

Endocrine function does not go in just one direction. The various female hormones affect thyroid metabolism and thyroid hormone affects how these hormones work in the body too.

So fasten your seat belts because it’s going to get complicated, but I’m going to make as easy as I can.

Let’s Review Some Physiology

First thing we should do before we dive in is to review what happens in a woman’s cycle hormonally. Then we can look how each hormone is impacted by Hashimoto’s and hypothyroidism.

Follicular Phase: Days 1-5: Estrogen Drops and FSH Rises

Menstrual bleeding begins on day 1 and normally lasts about 5 days. During the last few days leading up to day 1 there is a sharp fall in levels of estrogen and progesterone. This signals the uterus that pregnancy has not occurred during the cycle.

This signals starts the shedding of the endometrial lining of the uterus. Since estrogen suppresses FSH, when estrogen levels drop FSH levels rise. Follicle stimulating hormones, stimulate, yup, you guessed it the follicles.

By day 5-7 of the cycle, one of the follicles responds to FSH and becomes the dominant follicle.

When it does it starts releasing lots of estrogen.

Midcycle: Days 6-14: Estrogen Rises and FSH Falls

All good things must come to pass so the large amounts of estrogen released by the follicle during this phase has several important effects.

The endometrial lining of the uterus becomes thicker and is prepared for the fertilized egg. When this happens FSH gets suppressed (through negative feedback).

At about midcycle, this estrogen spike and FSH fall leads to the release of luteinizing hormone (LH).

This is known as an LH surge and this leads to a sudden rise in body temperature which is a sign that ovulation is about to happen.

This LH surge causes the follicle to break and send an egg into the fallopian tube.

Luteal Phase: Days 14-28 Estrogen and Progesterone First Rise, Then Fall

After the follicle frees the egg, its walls collapse and this is called the corpus luteum.

Right after ovulation, the corpus luteum begins secreting large amounts of progesterone, which also helps prepare the lining of the endometrium to accept and nurture the fertilized egg.

If the egg is fertilized, a small amount of a hormone called human chorionic gonadotropin (HCG – the hormone that is used in a popular diet treatment) is released.

HCG keeps the corpus luteum strong so it can keep pumping out estrogen and progesterone. This keeps the endometrial lining strong and intact.

By about week 6 to 8, if pregnancy has occurred then the newly formed placenta takes over and starts secreting progesterone.

Here’s Where It Gets Interesting

Thyroid hormone affects all of this and all of this affects thyroid hormone.

Hypothyroidism Messes with All of This

When women have hypothyroidism, a common problem is an increase of another hormone called prolactin.

This causes less of a release of LH, and a loss of progesterone receptor site sensitivity, and a loss in sensitivity to FSH in the follicle.

All of these losses lead to problems with ovulation, and they also mess with the communication to the pituitary gland.

Hypothyroidism can lead to lower levels of LH. Which means you don’t get an LH surge, which means ovulation may not happen properly.

Using birth control pills on top of this can further harm the communication and feedback loops in this system.

Using herbs to stimulate the ovaries or the reproductive system may also not work unless the hypothyroid issues are corrected.

Studies have found that even mild hypothyroidism may cause ovarian problems.

Testing thyroid function is very important with women who suffer from infertility, especially if they have elevated prolactin or they can’t ovulate.

Also, hypothyroidism can cause the development of ovarian cysts.

We looked at that in detail in a previous post where we look at the connection between PCOS and Hashimoto’s.

Hypothyroidism may also lead to low FSH levels, which may lead to immature follicles and infertility.

Suppressed LH levels will often lead to problems with ovulation in timing or abnormal luteal phase progesterone levels.

These changes may cause miscarriage, depression in the second half of your cycle, or migraines in the second half of your cycle.

To summarize, hypothyroidism can cause:

* A decrease in FSH release and FSH receptor sensitivity, this leads to problems with the development of the follicle and infertility

* Suppressed LH which leads to problems with ovulation and abnormal progesterone levels, this leads to abnormal cycles and infertility

* Progesterone receptor insensitivity which also leads to abnormal cycles and infertility

* Increased Prolactin, which leads to problems with ovulation, abnormal menstrual cycles and infertility

And It Goes Both Ways And Gets More Complicated

Prolactin has a very close relationship to dopamine, thyroid hormone, progesterone and serotonin.

All of these hormones and neurotransmitters affect each other. For example, low dopamine and progesterone can suppress TSH.

Also, hypothyroidism can affect the adrenals directly. It can cause too much cortisol to be released or over time exhaust the adrenals.

And this also suppresses TSH. So what happens is you get weird mixed test results and symptoms.

Mixed Messages and Confusing Signs

The presentation looks like this: TSH is normal or even slightly low, but you have a ton of hypothyroid symptoms and your T4 is low.

It doesn’t make sense. Everyone is confused. Well, it’s this complex dance of hormones that may be causing this.

Something else that is interesting to note is that high cortisol, which can be caused by hypothyroidism can dampen the activity of the enzyme that converts T4 into T3 (5 alpha deodinase).

So what happens is high cortisol causes low T3.

Estrogen increases thyroid binding globulin levels. These are the proteins that bind to thyroid hormone and keep it from working.

We see this with normal TSH and low free thyroid hormones (free T3 and free T4). This can happen with birth control pills.

This also explains why some women with hypothyroidism and Hashimoto’s experience tachycardia, tremors and hypothermia every month before their cycle.

High or Low Progesterone?

Progesterone up-regulates TPO (the enzyme thyroid peroxidase). This is why when women ovulate, their temperature goes up.

During ovulation, the surge of progesterone stimulates TPO.

When this happens there is a surge in thyroid hormones produced, that makes the temperature rise.

Women with low progesterone can also have less thyroid hormone than their body needs (even thought this isn’t always visible on a lab test.)

But they might have both low thyroid and low progesterone symptoms.

Symptoms of low progesterone include heavy menstrual cycle, inability to lose weight, mid-cycle luteal phase depression, headaches, etc.

It is interesting to note that problems with progesterone are often not caused by your body being unable to make enough progesterone, rather they are caused by some sort of problem with the pituitary gland.

There are a number of axises involved with the pituitary, the adrenal-pituitary, thyroid-pituitary and ovarian-pituitary connections can all affect each other and can lead to problems with this communication system.

This is always a better place to attempt treatment before adding external progesterone which can actually make Hashimoto’s symptoms worse.

What to Do?

Obviously, this is not something that a single pill is going to correct. Rather than look for the drug or supplement to solve the problem let’s look at how hormones behave and see how we can improve that.

The physiologic effects of hormones depend largely on their concentration in blood and extracellular fluid. Disease and health problems happen when hormone concentrations are too high or too low.

First thing to do is to test to determine whether or not you have enough hormone in your body. As we saw above with progesterone therapy, this can make matters worse if you supplement when you already have enough.

If there isn’t enough, you should consult your physician to help your body get or make more.

This can be done naturally or with supplementation and involves many different treatment options that are beyond the scope of this post.

How To Make Hormones Work Better

If there is enough of a given hormone in the body how do we get them to work better?

Well we need to get enough hormone to the target tissue so that it can work. The concentration of hormones is determined by 3 things:

1. The rate of production. How do you improve the rate of production? Well, firstly make sure you have enough of the raw materials in the body to make them.

Many important reproductive hormones are made from cholesterol.

While cholesterol often gets a bad rap, when it comes to hormone production and synthesis it’s critical.

A cholesterol lower than 150 means you may not have enough of the raw materials to make estrogen, progesterone, cortisol and many other important hormones in the body.

Here are some foods high in cholesterol:  eggs (especially fish eggs), liver, fish,  shellfish, shrimp, bacon, sausages, red meat, and brain which has the highest amounts (all you zombies, take notice).

Then look to improve the feedback mechanisms. Positive feedback can improve this.

2. The rate of delivery. Blood flow makes a huge difference for hormone delivery. If you are anemic and/or have low blood pressure you can pretty much guarantee that you won’t be able to deliver optimal amounts of hormones to your body’s tissues.

High blood flow delivers more hormone than low blood flow. This is a very important fact that is often ignored or disregarded, yet it makes a huge difference physiologically.

3. Rate of degradation and elimination.

Hormones all break down and are reabsorbed by the body, but things like a clogged liver and enhanced negative feedback loops can affect the amount of hormones that are released.

Thyroid hormones are basically a “double” tyrosine with the critical incorporation of 3 or 4 iodine atoms.

The circulating halflife of thyroid hormones is on the order of a few days. They are inactivated primarily by intracellular deiodinases.

Systemic inflammation, out of control blood sugar and high cortisol can all affect the activity of these enzymes.

As we stated above, female hormones like estrogen and progesterone are steroid hormones derived from cholesterol.

The thing that can limit the production of these hormones is the conversion of cholesterol to pregnenolone. Chronic stress can cause something called a “pregnenolone steal” where pregnenolone is siphoned off to make cortisol and is not available for other steroid hormone production.

So reducing stress and balancing blood sugar are also critical for the production of estrogen and progesterone.

Obviously, this is not easy to fix nor is it simple to figure out and correct.

However, doing a proper workup, and working with someone who understands positive and negative feedback interactions and creating an action plan that will use your body’s natural tendencies to your advantage are all important factors in getting better results.

At Hashimoto’s Healing we off a free 30 minute Discovery Session where we’d be happy to discuss this process with you. (Fair warning these are very popular and are currently booked 3 to 4 months out)

If you would like to speak to Marc sooner please contact us here.

References:

http://www.ncbi.nlm.nih.gov/pubmed/25750078 : L/T4 supplementation : These findings suggest that the thyroid gland and peripheral tissues are integrated in the physiological process of T3 homeostasis in humans via a feed-forward TSH motif, which coordinates peripheral and central regulatory mechanisms. Regulatory and capacity deficiencies collectively impair T3 homeostasis in L-T4-treated patients.

http://www.ncbi.nlm.nih.gov/pubmed/1585690 : Higher free T3 levels with birth control?

http://www.ncbi.nlm.nih.gov/pubmed/3107297 : Value of measuring free fractions

http://www.ncbi.nlm.nih.gov/pubmed/23184912: TSH testing not adequate

http://www.ncbi.nlm.nih.gov/pubmed/15588378 : short feedback

http://www.ncbi.nlm.nih.gov/pubmed/15481810: TRH feedback regulation

http://www.ncbi.nlm.nih.gov/pubmed/16876577: TRH Neurons

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3520819/ Elevated TSH and elevated cortisol: These studies all taken together suggest a physiologic feedback loop where lower thyroid function increases cortisol, but cortisol feeds back to reduce TSH; this hypothesis is consistent with the observations that in the case of primary hypothyroidism (elevated TSH) cortisol is elevated, but in the setting of primarily elevated cortisol TSH is suppressed.

http://www.ncbi.nlm.nih.gov/pubmed/16793944 – The effects of sex-steroid administration on the pituitary thyroid axis

http://aulanni.lecture.ub.ac.id/files/2012/01/Thyroid-Function-Testing-1441914846.pdf

Ben-Rafael Z, Mastroianni L, Strauss JF, Flickinger GL, Arendasch-Durand B. Changes in thyroid function tests and sex hormone binding globulin associated with treatment of gonadotropin. Fertil Steril. 1987: 48;318-320

Malarkey WB, Strauss Rh, Leizman DJ, et al. Endocrine effects in female weight lifters who self administer testosterone and anabolic steroids. Am J Obstet Gynecology. 1991;165:1385-90

Knopp RH, Bergelin RO, Wahl PW, Walden CE, Chapman MB. Chemical alterations in pregnancy and oral contraceptive use. Obstet Gynecol 1985;5;66:682-90

The Thyroid, A Fundamental and Clinical Text, Ninth Edition, Braverman and Utiger, 2005

Functional Endocrinology, Dr. Datis Kharrazian, 2007

HALogo

Hashimoto’s Awareness: Created to Bring Awareness and Fund Research into Hashimoto’s Thyroiditis

Hashimoto’s Awareness: Founded by 2 Hashimoto’s Patients

Pearl Thomas and Fabienne Heymans have both worked with me to get their Hashimoto’s into remission. I knew that they were both in New York and I suggested that they meet and support one another.

A short time later they contacted me about their passion to create a non-profit dedicated to people suffering from Hashimoto’s Thyroiditis.

I knew without hesitiation that this was an organization I wanted to support. I am proud to be on the Advisory Board of  Hashimoto’s Awareness, the organization that they created.

Here are their stories:

Written by Fabienne Heymans & Pearl Thomas, Hashimoto’s Awareness

Pearl and I were simultaneously raising awareness of the disease individually, holding our own support groups, had active Facebook pages, and we were exploring ways to expand.

At the time, Marc Ryan L.Ac. and functional practitioner, was giving us both consultations separately. One day, he suggested that we connect because we were both living in New York City and had the same passion to be of service to the Hashimoto’s Community.

On March 16, 2014, we met in Hu-Kitchen; now, our favorite paleo diet restaurant on 5th Ave. We immediately saw the possibility of creating something bigger than ourselves together! Our combined energy was effervescent and both of our big dreams coincided with each others.

We were both in remission from Hashimoto’s and passionate about sharing our journey with all who were still struggling with the disease. It was simply serendipitous! We became teammates and dear friends to-be. Together, we became unstoppable.

We immediately filed for a non-profit organization known as HA! Today, we have launched a campaign on Crowdrise.com and with the funds we are starting to organize the very first National Conference for Hashimoto’s Thyroiditis!

Fabienne’s Journey

Fabienne

Co-founder, Fabienne Heymans

 

It is truly by accident that I was diagnosed after being sick nearly all my life. I experienced highs and lows, as you all know, I am sure! The symptoms included brain fog, extreme fatigue, joint pain, hair loss, thinning skin, sensitivity to perfumes, just to name a few.

By February 2012, my immune system was at its worst! Menopause only made matters worse. I was scheduled for surgery to remove one of my parathyroid glands which was inflamed to twice its normal size!

The scan of the thyroid gland showed many patches on the tissue and a biopsy confirmed Hashimoto’s Thyroiditis. Yeahh, thank you God!!

Ironically, one of the best days of my life!! I finally had an answer to my question about why I had all these symptoms. I finally confirmed that, “NO, I wasn’t crazy” all these years!

The surgery was supposed to be a minor procedure. But, my body, after fighting all these years, on every level of my being, was emotionally, psychologically and physically exhausted.

After the surgery, I was not waking up from the anesthesia. The entire day went by and still I wasn’t coming back from the place between life and death.

To keep the story short, I finally woke up with the determination to make a difference for all the people that are in despair, struggling with Hashimoto’s, and who don’t know how or where to look for support.

All my life, the medical field insisted that all my lab tests were normal and therefore they claimed that my symptoms must be of psychological origin. I promised myself that no one should ever be in this position ever again and from there everything changed!

After reading Dr. Datis Kharrazian’s book, Why Do I Still Have Thyroid Symptoms? When My Lab Tests Are Normal I researched and found a Functional Practitioner in NYC. I learned the critical importance to stop eating gluten completely.

I started taking the right supplements according to Dr. Kharrazian’s protocol and I started feel significantly better.

Although the journey is ongoing, I have a strong support system and a great community as a resource when I need it. Today, I live a productive life in NYC and dedicate my days to empowering others with Hashimoto’s to live a symptom-free life.

Pearl’s Journey

Pearl

Co-founder, Pearl Thomas

I was diagnosed with Hashimoto’s Thyroiditis in February of 2012. I was fortunate enough to have been referred to a wonderful integrative physician who gave me proper testing for early diagnosis. Months leading up to my appointment, my personal trainer noticed my energy levels going down in our high intensity workouts.

I was cranky, my hairline was thinning and I was experiencing 2-3 inch hives on my calves, that were itchy, brown colored and stuck around up to three weeks. I took action and made an appointment for blood work.

Two weeks later, at my follow-up appointment, I was diagnosed. My TSH and TPO levels were off the charts. I was instructed to start a natural hormone medication Nature-throid, stop eating gluten, wheat, soy, and dairy and was instructed to start adding supplements such as Liquid D3, B-12, Omega 3’s, probiotics, and meditation. (Speak to your doctor before trying supplements to be sure they are right for you.)

At the time, I realized this was a serious condition and it was time to act NOW. I chose to start doing some research.

Fortunately, I stumbled across a book by Dr. Datis Kharrazian, who some call, the Functional Medicine Guru, the book is called, Why Do I Still Have Thyroid Symptoms? When My Lab Tests Are Normal and I started reading.

I found out that Hashimoto’s disease was killing my immune system, brain function, and circulatory system. Everything he wrote about from vitamin deficiencies to recommending a diet free of gluten, soy, wheat, corn and eggs; I was dumbfounded.

This book was my best friend. His research gave me hope that I could put this disease in remission quickly. I followed his protocol diet and began my journey to remission.

Six months later after following Datis’s protocol diet, I was sleeping better, finally losing weight, my hair was thicker, and I was no longer depressed or experiencing anxiety attacks. It was working. Changing my diet was working! I then went for my next round of blood work and my results came back, my TSH and TPO were now in normal range!

My doctor stated, “You are a miracle walking. I have not yet seen someone’s levels go up so quickly.” I was in full remission from the disease. And in that moment, I knew this was possible for others.

Today, after three years in remission, I’ve dedicated my life to being of service in the Hashimoto’s community. And through that, I am the Co-Founder and Co-Creative Director of the not-for-profit, Hashimoto’s Awareness.

I work alongside an incredibly talented and driven friend and kindred spirit, Fabienne Heymans, who is also in remission from the disease.

As we work with some of the top experts in the community, we have a great vision for this organization and how we might be of service in many ways to others.

We are committed to bringing clarity to the community that is in need of education on this serious disease and we believe we will make the difference worldwide.

What I will share with others struggling with the disease is that you are not alone. Remission is possible if you’re willing to do the work.

We are here to support you in an empowering way and we promise your journey to remission will be inspiring, powerful, and supported by a community that stands as your greatest fans.

About Hashimoto’s Awareness

We are committed to bringing clarity to the community of people suffering from the auto-immune disease, Hashimoto’s Thyroiditis. According to the AACE, 30 million people in the United States are diagnosed with hypothyroidism and 90 percent of those people have Hashimoto’s Disease.

HA is a registered 501(c)(3) non-profit organization.

Please Give If You Can!

We invite you to join us on our campaign page HASHIMOTO’S AWARENESS CAMPAIGN: “HEALING TOGETHER”!

Your donation allows HA to drive diagnosis and treatment of Hashimoto’s Thyroiditis through education, advocacy and advancing research.

Assortment of dairy products

With Hashimoto’s, sometimes the things that cause the most problems are the things we are most attached to. Dairy certainly falls into this category.

In this post we’ll look at the potential problems caused by dairy and Hashimoto’s. And, yes, that may include cheese and ice cream.

Dairy Can Compromise Your Health in 2 Ways

There are 2 distinctly different problems that can be caused by dairy consumption. The first is caused by milk proteins, the second is caused by milk sugars.

Let’s take a look at both.

Milk Proteins Have A Similar Structure to Gluten

Unless you’ve been living under a rock, you’ve probably heard about the benefits of going gluten free for people with Hashimoto’s. If this is a new concept to you, check out my previous post on this here.

Well, milk based products have a host of proteins that also can and do cause immune reactions. These include casein (alpha & beta), casomorphin (a protein that closely resembles morphine), milk butyrophilin, and whey.

These proteins are known as “cross-reactors” because they closely resemble gluten proteins and can cause a similar immune response in the body.

In a lot of cases these are undiagnosed and people continue to eat these foods and/or are advised to eat these foods and they end up hurting themselves by damaging their intestines and robbing themselves of important nutrients.

There are different parts of the immune system that react to these foods; IgE, IgA and IgG reactions.

Understanding the Difference Between IgE, IgA and IgG

Food allergies are mediated by the IgE part of the immune system. These generally casue an immediate reaction and are often what is called a “true allergy” by doctors and other medical professionals. However, this is not the only type of food reaction your body can have.

IgA and IgG systems can also lead to hypersensitivities. These are sometimes termed “food intolerance” or “food sensitivity.”

The important thing to understand is that they are much different in their mechanism and ability to wreak havoc in your body.

IgA Food Reactions

IgA food intolerance is the more severe reaction and happens mostly in the intestines. It is an abnormal response of the intestines to certain foods in genetically predisposed individuals. The intolerances may manifest themselves early in childhood, or later in life.

IgA food intolerance results in irritation and inflammation of the intestinal tract every time that particular food is consumed. This results in damage to the intestines, and eventually it hurts your ability to absorb nutrients, and can increase the risk of autoimmune diseases, cancer, and accelerate aging through increased intestinal permeability or leaky gut.

IgA food intolerances can also vary in their symptoms considerably. They may be asymptomatic, may be neurological or they may present with the following symptoms: diarrhea, loose stools, constipation, acid reflux, malabsorption of nutrients from foods, and increased intestinal permeability.

They can cause IBS, gas, nausea, skin rashes (including eczema), acne, respiratory conditions such as asthma, nasal congestion, headache, irritability, cognitive problems and vitamin/mineral deficiencies.

The most famous IgA food reaction is “celiac” disease, and it is an intolerance to gluten, the protein found in wheat. We have looked into how this impacts Hashimoto’s extensively. Check out our previous post here.

However, dairy protein, egg, and soy protein IgA intolerances are also extremely common in people with Hashimoto’s. These intolerances do not have a specific name, and may be confused with other, less severe food absorption syndromes.

IgG Food Reactions

These are antibodies that provide long-term resistance to infections, called Immunoglobulin G (IgG), and they have a much longer half-life than the traditional IgE allergy. These reactions can be much more subtle and people can live with them for years, if not their entire lives.

Symptoms, ranging from headache and nausea to seizure and hyperactivity, or simply just fatigue, bloating, mood changes brain fog, memory problems or dark circles under the eyes. They may occur hours or even days after the problem food has been ingested.

Food allergy tests like the ALCAT test, test both IgA and IgG reactions to foods. A positive or equivocal finding of IgG against foods may indicate that the person has been repeatedly exposed to food proteins recognized as foreign by the immune system.

This matters with thyroid autoimmunity because this process can fire up the very same parts of the immune system that are already attacking our own tissue. In fact, Antithyroglobulin antibodies (TgAb) and antithyroperoxidase antibodies (TPOAb), predominantly of the immunoglobulin (Ig) G class, are hallmarks of Hashimoto’s.

Researchers have recently discovered that there are 2 types of IgG proteins, IgG4-positive and IgG4-negative. Further studies are needed to determine exactly what the difference between them is. But this may have clinical and treatment ramifications.

The degree and severity of symptoms vary greatly because of the genetic makeup of the individual. The complete elimination of IgG positive foods may bring about important improvements in Hashimoto’s symptoms because this can be a key factor in calming autoimmunity.

Dairy Allergies and Dairy Intolerance Are 2 Different Things

Often people confuse the food immune reactions to dairy mentioned above and milk intolerance which is caused by milk sugars known as lactose.

One thing that people don’t always realize is that even tiny amounts of lactose can have a major impact on our ability to absorb thyroid medications. Worst of all, some thyroid medications actually contain lactose, defeating their own purpose!

Lactose Can Make Thyroid Hormone Not Work As Well

A recent study published in 2014 by Asik and colleagues found that lactose intolerant Hashimoto’s patients who were taking levothyroxine showed a decrease in TSH after lactose restriction.

In other words, removing lactose improved how their levothyroxine was working.

Another study from August 2014 had a similar finding. This was published in the Journal of Clinical Endocrinology and Metabolism by Cellini and colleagues and found that lactose intolerance increased the need for more thyroid medications.

The researchers found that the average person with Hashimoto’s required an average dose of 1.31 mcg/kg/day of levothyroxine to get to an average TSH right around 1 mU/L (that would be right around 75 mcg of levothyroxine for a 125 pound person), while a person with Hashimoto’s and lactose intolerance who continued to consume lactose needed a dose of 1.72 mcg/kg/day to reach the same goal (that would be like 100 mcg of levothyroxine for the same 125 pound person- that’s quite a bit more).

In addition, patients who had other gut disorders in addition to lactose intolerance required an even higher dose to get to their goal TSH 2.04 mcg/kg/day, or around 116 mcg for a 125 pound person. So you can see, the more gut related issues the higher the dose to achieve the same effect.

If your TSH levels are jumping up and down and you’re having a hard time controlling them, dairy protein immune responses and lactose intolerance should be top on your list of suspects.

How Common is Lactose Intolerance in Hashimoto’s?

Lactose intolerance rates in Caucasians have been reported to be between 7% to 20%, and much higher those in those of Asian and African descent. Lactose intolerance can be secondary to other conditions and reversible or it can be genetic and permanent.

A recent 2014 study by Asik and colleagues tested 83 Hashimoto’s patients for lactose intolerance and found lactose intolerance in 75.9% of the patients. I’d say that would qualify as pretty darn common!

38 of those patients were instructed to start a lactose free diet for 8 weeks, and the researchers found that over this time, the patients’ TSH dropped, meaning, they were absorbing their thyroid medication better.

If You Are Lactose Intolerant A Tiny Amount Can Cause Problems

For some lactose intolerant people, even tiny amounts of lactose that are found in thyroid medications can be an issue, causing impaired absorption of thyroid medications. Yes, what we’re saying is that thyroid medications could be undermining their own absorption if they contain even teeny amounts of lactose.

So if you are someone that can’t get his/her TSH into your “Goldilocks zone” – where it’s just right (there is much debate about where this is, but general consensus is that TSH should be somewhere between 0.5-2 mU/L for people to feel best) despite taking higher and higher doses of thyroid medications, consider lactose intolerance and the possibility that the lactose in your diet or even in your thyroid medication may be hindering its absorption.

And here’s the thing, the reality is you could have both lactose intolerance and be having an immune reaction to diary proteins. This is a potent and destructive double whammy for people with Hashimoto’s. Which, as you should know, is an autoimmune disease of the thyroid!

So dairy can potentially wind up autoimmune tissue destruction and prevent thyroid hormone from working. The result is a rapidly accelerating decline in thyroid function.

Just Give Up Dairy 100%

Some people will ask, “What about Lactaid?” They sometimes ask this because they can’t bear the idea of living without dairy products such as cheese and ice cream. And the logic makes sense to some degree. The problem is it doesn’t really solve the long term damage and potential problems.

It’s a little bit like an alcoholic taking the drug Antabuse and continuing to drink. The real problem is alcohol. And the real problem for some people is dairy.

As far as diet, I have seen tremendous improvements in my own health and the health of my clients and readers on a dairy free diet, so this is something that I strongly recommend for everyone with Hashimoto’s.

SOME THYROID MEDICATIONS CONTAIN LACTOSE

If you weren’t aware of it, here are some common medications that contain lactose as a filler and some that are lactose free.

·      Synthroid

·      Euthyrox

·      WP Thyroid

·      Nature-Throid

·      Most generic brands of levothyroxine

·      Some compounded medications- check with your pharmacist

LACTOSE FREE THYROID MEDICATIONS

·      Tirosint

·      Armour Thyroid

·      Cytomel

·      Levoxyl

·      Some compounded medications may use lactose as a filler – check with your pharmacist

Medication Tips

Of all of the T4 containing medications, Tirosint has the fewest fillers that may affect absorption, and this medication was designed for people with these types of intolerance. This medication is recommended if you suspect you may have problems with dairy and lactose.

Of course, some people do better with the addition of T3. Of all of the T4/T3 combination medications, WP Thyroid has the fewest fillers that can impair absorption. However, it does contain trace amounts of lactose, as well.

Armour thyroid does not contain lactose, but contains corn derived ingredients that can be problematic in corn sensitive individuals and can trigger a gluten like reaction.

When they changed their formulation a few years ago, some people did very poorly with the new mixture, and one of the reasons was this corn based filler.

Other Factors Contributing to Medication Absorption

Another really interesting research finding is that high TSH can simply be caused by absorption disorders like lactose intolerance, celiac disease, atrophic gastritis, H. Pylori infections, inflammatory bowel disease and/or parasites.

All of these issues commonly prevent people from getting their Hashimoto’s into remission, as well. These are more positive feedback loops and they cause vicious cycles that lead to poor results in different systems of the body.

This is a perfect example of how this is not just a thyroid problem. Thyroid hormone metabolism is dependent on other systems of the body.

A 2012 Polish study by Ruchala and colleagues reported that thyroid patients who need more that 2 mcg/kg/day of levothyroxine with an increased TSH should be suspected of having an absorption disorder like the ones mentioned above.

Bottom Line:

Get off of dairy 100%. Treat it the same way you treat gluten and understand that the misery it can cause if not worth the buzz of an ice cream cone or some cheese on crackers.

Also understand that having “just a little bit” is not really solving the problem at all. A tiny amount can be a tsunami to your immune system and can lead to a whole cascade of problems.

Being “sort of dairy free” is like being “sort of pregnant”. It’s not a real thing.

References:

http://www.ncbi.nlm.nih.gov/pubmed/23992023 IgG proteins in Hashimoto’s

 http://www.researchgate.net/publication/271022933_Thyroxine_softgel_capsule_in_patients_with_gastric-related_T4_malabsorption – The influence of lactose intolerance and other gastro-intestinal tract disorders on L-thyroxine absorption. Endokrynol Pol. 2012;63(4):318-23.

http://www.ncbi.nlm.nih.gov/pubmed/24078411  Asik, et al study

http://press.endocrine.org/action/doSearch?AllField=lactose+intolerance+and+thyroxine – Systematic appraisal of lactose intolerance as cause of increased need for oral thyroxine. J Clin Endocrinol Metab. 2014 Aug;99(8):E1454-8. doi: 10.1210/jc.2014-1217. Epub 2014 May 5. PMID: 24796930

http://www.ncbi.nlm.nih.gov/pubmed/17123345 Lactose intolerance revealed by severe resistance to treatment with levothyroxine. Thyroid. 2006 Nov;16(11):1171-3.

http://labeling.pfizer.com/ShowLabeling.aspx?id=688&mc_cid=3f79b51f37&mc_eid=c1f303f62b Levoxyl – Levoxyl

http://www.rxlist.com/tirosint-drug.htm – Tirosint

http://www.pdr.net/full-prescribing-information/wp-thyroid?druglabelid=3202 – WP Thyroid

 Marc Ryan, L.Ac. Founder of Hashimoto's Healing

Clinical Pearls from Working in the Trenches 

Hey, people!

Wow! Another year has flown by.

We’re celebrating the second anniversary of launching our website and Facebook group.

I am a big fan of looking back at the data and the experiences and analyzing what we learned.

And, hopefully, we can continue to build from that and improve what we are trying to do.

And that is to help and educate people to heal their Hashimoto’s.

Over 1,500 Consultations With People With Hashimoto’s

Over the course of these 2 years, I have had over 1,500 consultations with people with this disease.

I’ve listened as people described their symptoms, their struggles and their health histories and I’ve also taken a number of surveys and polls at our Facebook support group which has now reached 22,000 Likes.

I want to thank everyone who has joined us for their continued love and support!

This is something we could not have achieved without you.

You truly inspire me day in and day out!

A PRACTICE NOT ANALYZED IS NOT WORTH LIVING

In this blog post I’m going to summarize the top 3 things that I think are really important (from a clinical and practical point of view) and I’ll share a few odds and ends that are just really interesting to me.

And, just so you know…

Much of what we have learned over last 2 years will be summarized in my new book which is due out at the end of April 2015 called Road Map to Remission: A Practical Guide to Hashimoto’s Healing

It’s basically an owner’s manual for living with a Hashimoto’s body.

You can learn more about it here: Check out a video series on my new book.

If you haven’t yet done so, sign up to get on our email list so you can get all the latest updates, videos and research on Hashimoto’s.

Top 3 Clinical Pearls

Here are my top 3 clinical pearls and a little discussion on each and why I believe they matter to you.

Pearl #1: The Digestive Tract Is Ground Zero For Hashimoto’s and Autoimmunity

The more I work with people and help them turn their lives around, the more I realize that the digestive tract and, in particular, the intestines are ground zero for Hashimoto’s and autoimmunity.

And I can’t tell you how many people have shared with me that their doctors said that diet doesn’t matter.

Saying diet doesn’t matter for Hashimoto’s and hypothyroidism is kind of like saying alcohol doesn’t matter to an alcoholic.

The importance of diet can not be overstated and this is really a “no brainer”.

Yet, I am also continually surprised at how many people refuse to accept this or want to negotiate a kinder, gentler half way approach that doesn’t involve them changing their diet and, of course, their lives.

Hashimoto’s is an autoimmune disease and that means that your immune system is attacking your your own tissue.

Tissue attack and destruction is induced by immune system stimulation.

Where is your immune system?

An estimated 70 – 80 % lives in your digestive tract.

So everything that passes through there interacts with your immune system.

Also, there is a lot of research evidence that shows a clear link between “leaky gut” or intestinal permeability and autoimmune disease.

The breakdown of your intestines is a breakdown in the barrier to your immune system and this clearly is a factor in the initiation of autoimmune disease.

But it is also an important factor in people’s symptoms because if this is not addressed you have constant immune stimulation and constant tissue attack.

And this is not reserved for only the digestive system.

It’s effects are systemic. It has a ripple effect all over your body.

My advice is always get off of gluten, dairy and soy 100% and for many, because of the state of their intestines, this is not enough.

They need to do more.

For almost everyone, we recommend a version of the Autoimmune Paleo diet designed for autoimmune disease and Hashimoto’s, in particular.

And while you’re doing this, it’s a great time to work with someone like me because you can get a lot accomplished by working aggressively to heal the gut, clean up the liver and reduce systemic inflammation at the same time.

I have gotten messages on Facebook and emails from hundreds of different women and men who have credited this mind shift and change alone with completely transforming their lives.

If you’re on the fence about your diet, you’re just prolonging your misery needlessly.

It’s such a simple part of the solution.

Pearl #2 Hashimoto’s Has A Profound Impact On The Brain

This last year I became a bit obsessed with this area of study and research.

In fact, I did a video series and created a special program for it.

If you haven’t had a chance to see that yet, here’s a link: SAVE YOUR BRAIN (FROM HASHIMOTO’S)

(There’s 3 parts. The first 2 describe the issues and the third tells you about the solution.)

Why did I decide to give his so much attention?

Because, brain fog and memory issues are the number 2 problem for everyone with Hashimoto’s.

(Fatigue is number 1 and that is often brain based, as well. So you could argue that this is priority #1)

And here’s why it matters.

When you lose your brain, you lose everything.

The problems that Hashimoto’s can cause are relatively minor compared to what happens if neurodegeneration and autoimmunity inthe brain progresses past a certain point.

This can be a major factor in Alzheimer’s or Parkinson’s type symptoms and it can lead further to something like Hashimoto’s Encephalopathy.

Because Hashimoto’s (often the combination of hypothyroidism and autoimmunity) does a double whammy on the brain.

This leads to massive inflammation of the immune system in the brain which, in turn leads to major destruction of neurons and brain tissue.

The immune system in the brain is not like the immune system in the rest of the body.

It has 2 speeds, balls to the wall and calm. There’s no middle ground.

And there’s no off switch. No regulatory part of the immune system to calm it down.

It goes crazy until it can’t go crazy any more.

And when the immune cells in the brain (the microglia) get excited and activated, they chew up everything around them.

This is not good.

This process also has a profound impact on how you feel.

The anxiety, depression and inability to handle stress are not coincidences, they are another example of how this process upsets thebalance of your brain’s neurochemistry.

Neurotransmitters like serotonin, dopamine, acetylcholine, catecholamines and GABA are all impacted and can become deficient in people with Hashimoto’s.

These are you “molecules of emotion”.

They are directly responsible for your emotional health and well being.

And guess what else has a huge impact on the brain?

The gut.

The digestive tract is really the body’s second brain.

And these 2 interact with each in very important and significant ways.

So this is really one big pearl of wisdom.

Focusing on healing these 2 areas long term may just give you the greatest return on your investment of time, energy and money.

Pearl #3 A Relatively Small Number of Things Cause Most of Your Problems or the 80/20 Principle

Another epiphany I had this year was discovering something called the 80/20 principle.

This is often used in business and in marketing, but the idea has universal applications because it comes from a basic law of nature.

It’s also called the Pareto Principle because it came from an economist named Vilfredo Pareto.

He observed that 80% of the wealth in his country was owned by 20% of the people.

Ok, so what does this have to do with Hashimoto’s?

Stay with me for a moment…

Well, it turns out that this basic idea applies to just about everything in the natural world.

Look around you…

…Most people spend 80% of their time with 20% of their friends.

…Look in your closet, you wear 80% of those clothes 20% or less of the time.

And on and on.

You can apply this to everything, including your body and your health.

And it’s not about the numbers, ok?

It might not be exactly 80/20, it could be 85/15 OR 75/25.

The point is that there is an imbalance in cause and effect.

Relatively few things cause the majority of results.

Why does this matter?

Well with Hashimoto’s, this means 80% of our problems are caused by 20% of the things we need to work on.

Or let me put it another way:

If you are like many of the people that I have worked with, then 80% of your symptoms are caused by 20% of the choices you made today…

…now imagine if you could fix 80% of your symptoms fast by figuring out what those 20% are and then make some changes…

…and get that 20% to really count…

You see where I’m going with this?

Well, obviously, if this is true, we need to figure out what the 20% is.

And I believe that I have a good idea where to start.

Spoiler alert! You just learned 2 important parts of this 20%.

The brain and the gut.

If we had just 30 seconds together before I was whisked away in a black sedan by terrorists, here’s what I’d tell you.

The Key To Healing Is Often Doing Less

This seems like an over simplification, but it’s one of those things that is a fundamental truth.

Many of us who struggle with Hashimoto’s spend an enormous amount of time searching for the right information, the right doctor, the right drugs or combination of drugs and the right supplements.

But often the solution is right in front of us and it doesn’t require doing anything more.

It requires a steadfast devotion to doing less.

We’ve been conditioned in our consumer driven society to always want more.

And we’ve also been conditioned to think the answer is in a pill.

The pill that will deliver more is seductive and difficult to resist.

But the truth, for many, the most successful things you can do to feel better requires the ruthless application of simplifying your life.

If you really want to get better and find remission, become passionate about doing less.

And look at every part of your life. Especially at those things that you do compulsively.

Eat less sugar.

Watch less tv.

Read less news.

Spend less time with people who don’t support you or bring you joy.

Do less of the things that cause you stress.

And when you identify those things that are among the 20% that cause 80% of your misery.

Give them up 100%.

At the end of the day, this approach not only makes you healthier, it also gives you a much more rewarding life.

Odds and Ends

These were some interesting observations I have made:

1. More than 80% of the people I worked with had Mono and were exposed to the Epstein Barr Virus.

Clearly this virus is somehow involved in Hashimoto’s. How? The research is far from definitive. Theories include activation of NF Kappa Beta, activation of rouge B cells and proteins like IL-8.

Other common infections that are involved in the initiation of Hashimoto’s include Lyme disease, Yersenia and Herpes Viruses.

2. The most common symptom is fatigue.

Of all the many potential symptoms of Hashimoto’s fatigue is by far Public Enemy #1.

And fatigue is often brain based which means it is the result of neurodegeneration caused by hypothyroidism and autoimmunity in the brain that we mentioned above.

3. The disease is progressive. My teacher and mentor, Dr. Datis Kharrazian and others have identified 3 stages. Read this post to learn more about this.

4. Many people have more than one autoimmune disease or at the very least antibodies to other tissues.

The truth is that most doctors don’t test for or look for it. But, very often, it’s there.

One of the most common places for these additional antibodies is to brain tissue, especially cerebellar tissue.

And one thing I stress is that this matters because it means that the stakes are very high.

Autoimmunity to different parts of the body is the same basic process and it just finds different tissue.

And some of the places it can go can be life threatening.

This part of the equation must be taken very seriously.

And at it’s root what is autoimmunity?

Destructive inflammation.

And this means that reducing inflammation needs to be job 1.

And the best way to do that is to create an anti-inflammatory life.

This is without exception a simpler life because all the common excesses are known to cause more inflammation.

Well, that’s all for now.

I can’t wait to see what this next year will bring!

And if you’re not aware of it, I offer a free 30 minute Hashimoto’s Healing Discovery Session.

In it you can share your story with me. Tell me where you are and where you want to be.

I’ll make some recommendations that I think will help right away and we can discuss how else I might be able to help.

I set aside time every week to talk with people who have Hashimoto’s and I’d love to talk to you.

You can schedule a free session by clicking here.

Just a warning. These are all booked out 2 to 3 months in advance.

If you have a more pressing issue and you’re interested in working with me, shoot me an email at marc@hashimotoshealing.com and we’ll set aside time for you sooner.

Best,

Marc

gliadin a protein attacked in celiac disease

Gliadin, a gluten protein

Many people who suffer from Hashimoto’s are aware that there may be problems caused by eating gluten and related proteins.

However, because of misinformation and the inconvenience of going gluten free, many people ignore these warnings or don’t think this really applies to them.

I have had a number of people write me and tell me during consultations that they need to see “peer reviewed studies” about gluten and Hashimoto’s before they are going to commit to going gluten free.

In this post we examine a boat load of research on this subject and we seek to demonstrate, once and for all, why eating gluten is not a luxury you and your thyroid (and lots of other important parts of your body – like your brain) can afford.

Celiac Disease is an Autoimmune Disorder

According to the Celiac Support Association “Celiac disease, also known as celiac sprue or gluten-sensitive enteropathy, is a genetically linked autoimmune disorder that can affect both children and adults…”

Yes, celiac disease is an autoimmune disease. It’s not just a food allergy or sensitivity.

What do we know about autoimmune disease?

When you have one, it’s easy to get others.

Like Hashimoto’s, for example.

To read more about this, check out my previous post that looks into this in depth.

“…In people with celiac disease, eating certain types of grain-based products sets off an immune mediated response that causes measurable damage to the small intestine.”

Another key point. I and many other specialists in this field believe that the small intestine is ground zero for autoimmune diseases of all kinds.

This damage to the small intestines has systemic consequences.

These include the immune system, the endocrine system, the nervous system and the brain. This is no small matter (pun intended).

“…This, in turn, interferes with the small intestine’s ability to absorb nutrients in food, leading to malnutrition and a variety of other complications.”

Yes, the other complications include an inability to convert and absorb thyroid hormone, major deficiencies in important vitamins and minerals like iodine, iron, selenium, magnesium and vitamins like B, D and plenty more.

Pretty much guaranteeing hypothyroidism and thyroid gland dysfunction.

“…The offending amino acid sequences are collectively called “gluten” and are found in wheat, barley, rye, and to a lesser extent, oats* (WBRO). Related proteins are found in triticale, spelt, and Kamut.”

Indeed, these “offending amino acid sequences” are not just found in these grains, they are found in many foods like dairy, soy, coffee, corn, potatoes, and lots more.

The reality is gluten may just be the tip of the iceberg and going gluten free may not be enough to effectively treat autoimmune disease.

Some people do not get better by only going gluten free. This is not because they don’t have a problem with gluten.

There are many other foods that have a similar amino acid sequence to gluten and these may also be a problem.

Because it is these amino acid sequences that the immune system attacks and that resemble our own tissues. (To learn more about this, check out this previous post).

Celiac Disease Creates Antibodies that Attack Tissue Transglutaminase

Tissue transglutaminase is an enzyme that repairs damage in the body. People with celiac disease often make antibodies that attack this enzyme.

Well, studies have shown that people with transglutaminase and gliadin antibodies also have a much higher levels of TPO and TgAB antibodies.

A Major Link Between Celiac Antibodies and Thyroid Antibodies and Autoimmunity

Celiac Disease and autoimmune thyroid disorders share a common genetic link, namely, the DQ2 allele.

This is a subtype of a region of cells called the HLA (or Human Leucocyte Antigen) System.

There is a region on cells located on some of our genes called the HLA. Many of these are located on chromosome 6 (for those of you keeping count).

Mutations or defects of HLA have been linked to many different autoimmune diseases.

Exactly what happens is not known, there are numerous theories, but the end result is that our own tissue gets attacked and destroyed by the immune system.

With Celiac disease and autoimmune thyroid diseases we see an increase in both types of antibodies that lead to attack on these tissues.

Collin et al found 5.4% of 335 adult celiac patients, of whom 83% complied with a gluten-free diet, had autoimmune thyroid disease (autoimmune hypothyroidism or Graves’ disease).

Counsell et al found that 14% (15 out of 107) of celiac patients had thyroid disorders (3.7% hyperthyroid and 10.3% hypothyroid).

The same authors also noted a high prevalence of thyroglobulin antibodies (11%) and thyroid microsomal (TPO) antibodies (15%) in their CD patients.

Likewise, Velluzzi et al found the prevalence of thyroid peroxidase antibodies to be higher in CD (29.7%, 14 out of 47 patients) than in healthy controls (9.6%).

“Yes, But I Was Tested For Gluten Antibodies and The Tests Were Negative”

This is another area of misinformation. Most doctors test for 2-4 gluten antibodies.

Current testing for Gluten-Reactivity and Celiac disease (CD) includes serum IgG and IgA against gliadin and tissue transglutaminase-2 (tTG2).

These antibodies are measured against minor components of a wheat protein called alpha-gliadin.

Here’s the thing, wheat consists of multiple proteins and peptides including, alpha-gliadin, omega-gliadin, glutenin, gluteomorphin, prodynorphin, and agglutinins.

And there are many we still do not know about.

And the important thing to understand is that any of these antigens can cause an immune response.

So, even if you tested negative to celiac, you could still have gluten sensitivity or silent celiac disease because you may not have tested for the right thing.

Which Came First, The Gluten or the Autoimmunity?

This is a really interesting question that is controversial and no one really knows.

But, here’s what we do know.

Autoimmunity doesn’t just happen for no reason. It is the result of a perfect storm of factors.

You need the genetic predisposition (like the HLA DQ2 allele mentioned above), you need exposure to some antigen (Often Yersenia, Epstein Barr, Coxsackie, Lyme disease or some other pathogen), these produce antibodies and somehow you get the breakdown of mucosal IgA and tight junction proteins.

Ground zero is the intestinal mucosa.

One theory is that gluten, which is sticky and invasive (like a thief who can get into anywhere it wants), gets into the intestines, into the spaces between the intestines (the tight junctions) and eventually into the bloodstream.

Then the immune system kicks in.

Antigen presenting cells like macrophages (those Pac man cells that munch the bad guys) start attacking and they stimulate the T helper cells.

These are either TH-1 or Th-2 (check out this previous post that describes this works with Hashimoto’s in detail) and these lead to pro-inflammatory immune cells and proteins, more antibodies, cross reactions – generally, all hell breaking loose.

And, finally as this plays out and is repeated over and over again every time you eat a piece of bread, a pastry, some cake, a doughnut, etc. you are unknowingly pushing your body further and further into autoimmunity.

Your immune system is so juiced it doesn’t know which way is up and eventually, you loose self tolerance.

And loss of self tolerance means the immune system starts attacking your own tissue.

Another problem caused by gluten is that it makes thyroid hormone less effective.

Celiac Disease Has A Major Impact on Thyroid Hormone Absorption

An interesting study published by the American Thyroid Association found “…This study examined 68 patients with Hashimoto’s thyroiditis alone and 35 patients with Hashimoto’s thyroiditis and celiac disease.

The average dose of levothyroxine needed to treat patients with Hashimoto’s thyroiditis alone was lower than the average dose required to treat patients with Hashimoto’s and celiac disease.

When the patients with celiac disease went on a gluten-free diet while staying on the same dose of thyroxine, their TSH level decreased, indicating that their absorption of thyroxine had improved.”

We see this clinically all the time.

When patients go gluten free, they often must reduce their dosage of thyroid replacement hormone because it starts to work so much better.

Well, thyroid hormone produced by your thyroid and thyroid replacement hormone have the same structure.

Gluten prevents thyroid hormone produced by your thyroid from being absorbed, as well.

Is There Evidence That Gluten Leads Directly To Destruction of the Thyroid?

One idea that is often discussed in this context is something called molecular mimicry.

This is what happens when the immune system identifies certain proteins or protein fragments (amino acid sequences) and then attacks everything that has that amino acid sequence.

With autoimmunity, when the immune system attacks a virus like Epstein Barr, for example, it activates certain kinds of B cells.

These differentiate into plasma cells and one theory is that these may also stimulate anti-self B cells.

These are present in normal people and are there because our immune system constantly gets rid of old dead cells from our body.

But somehow these viral fragments cause other immune proteins called complement to stick to our own tissue and when they accumulate the immune system starts attacking that living tissue as well.

Viruses may also down regulate the T suppressor cells that call off the attack and this keeps the carnage going.

This is what happens to the thyroid. Thyroid cells get attacked as does the enzyme thyroid peroxidase and the protein thyroglobulin.

There is plenty of evidence that gluten is involved with firing up autoimmunity, but I could not find any actual research to support the claim that gliadin proteins closely resemble thyroid tissue (which is something that many bloggers in this area repeat).

There is no question exposure to gluten leads to autoimmunity, destruction of the small intestine, systemic inflammation and destruction of the thyroid.

But whether this type of molecular mimicry is at play is not clear. (I invite any readers to show me this actual research.)

However, at the end of the day, this hardly matters. There are so many other reasons not to eat gluten. And here’s another really big one.

Gluten Causes Neurodegeneration in Your Brain

Another really good reason to stay far away from gluten is that it has been linked to destruction of the brain, especially the cerebellum.

The brain is profoundly impacted by Hashimoto’s.

Check out this video (SAVE YOUR BRAIN (FROM HASHIMOTO’S) to learn more.

This is the reason why the second most common symptom for people with Hashimoto’s is brain fog and memory issues. (The most common symptom is fatigue.)

A condition of advanced neurodegeneration that results from Hashimoto’s is called Hashimoto’s Encephalopathy.

This destroys parts of the brain in much the same way that Alzheimer’s does.

And this is caused by autoimmunity in the brain.

One area of the brain that can be impacted is the cerebellum. And a common symptom of impairment to the cerebellum is ataxia.

Ataxia is uncoordinated movement is due to a muscle control problem.

It leads to a jerky, unsteady, to-and-fro motion of the middle of the body (trunk) and an unsteady gait (walking style). It can also affect the limbs.

You can test this by doing the DUI test. Close your eyes and imagine you are walking on a tight rope, put one foot in front of the other.

If you lose your balance or fall over, this may indicate some impairment of the cerebellum.

Guess what else causes ataxia?

Gluten.

In fact, a study from Brain a Journal of Neurology, 2003 found “Gluten ataxia is therefore the single most common cause of sporadic idiopathic ataxia.”

The most common cause of ataxia that has no known explanation.

So when you combine Hashimoto’s with brain autoimmunity and gluten, you have a recipe for really bad things.

And Wait There’s More

The final pièce de résistance of this post is something that is related to gluten but adds a whole other layer of badness.

That is glyphosate or Monsanto’s marquee product Roundup.

Glyphosate is sprayed on wheat and many other grain crops just before harvesting to make them dry out more uniformly.

Well, it turns out that this chemical also does a number on the small intestine, may be responsible all by itself for the destruction of the intestinal lining and the initiation of a host of diseases.

Fish exposed to glyphosate develop digestive problems that are a lot like celiac disease.

Celiac disease is associated with imbalances in gut bacteria that can be fully explained by the known effects of glyphosate on gut bacteria.

Characteristics of celiac disease point to impairment in many cytochrome P450 enzymes, which are involved with detoxifying environmental toxins, activating vitamin D3, catabolizing vitamin A, and maintaining bile acid production and sulfate supplies to the gut.

Glyphosate is known to inhibit cytochrome P450 enzymes.

Deficiencies in iron, cobalt, molybdenum, copper and other rare metals associated with celiac disease can be attributed to glyphosate’s strong ability to chelate these elements.

Deficiencies in tryptophan, tyrosine, methionine and selenomethionine associated with celiac disease match glyphosate’s known depletion of these amino acids.

Celiac disease patients have an increased risk to non-Hodgkin’s lymphoma, which has also been implicated in glyphosate exposure.

So Let’s Review:

Here are 5 reasons to never touch gluten as long as you live that are supported by about 30 peer review studies listed below.

1. Celiac Disease is an Autoimmune Disease with striking similarities to Autoimmune Thyroid Disease.

2. People with Celiac, and Gluten Sensitivity have higher levels of thyroid antibodies and visa versa.

3. Gluten can destroy your small intestines and cause deficiencies in important nutrients, vitamins, and minerals absolutely necessary for proper thyroid function.

4. Gluten and Celiac Disease block the absorption of thyroid hormone.

5. Gluten can cause neurodegeneration in your brain.

And a Bonus

6. Commercial wheat also has lots of glyphosate, a chemical that can make all of what we have just mentioned a whole lot worse.

Bottom Line

In life we must always make decisions based on risk and benefit.

The risk of the destruction that gluten can cause in people with Hashimoto’s so far outweighs the benefit that it is really no contest.

References:

http://www.csaceliacs.org/celiac_disease_defined.jsp

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2111403/ Celiac Disease and Autoimmune thyroid disease

http://www.ncbi.nlm.nih.gov/pubmed/18176874 North Italian prevelance of CD in autoimmune thyroid

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC96126/: CD and autoimmune endocrinopathies

http://www.eje-online.org/content/130/2/137.abstract Autoimmune thyroid disorders and celiac disease

http://www.ncbi.nlm.nih.gov/pubmed/15244201 Antigliadin antibodies in celiac disease

http://www.ncbi.nlm.nih.gov/pubmed/9872614 Autoimmune thyroid diseases and celiac disease

http://www.ncbi.nlm.nih.gov/pubmed/12919165 Risk factors of thyroid autoimmunity

http://www.ncbi.nlm.nih.gov/pubmed/11768252 Autoimmune thyroid disease in celiac patients

http://chriskresser.com/the-gluten-thyroid-connection

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3725235/ Celiac disease and autoimmunity: excellent overview

http://cvi.asm.org/content/8/4/678.full Celiac related autoimmune endocrinopathies

http://www.direct-ms.org/pdf/LeakyGutMS/Fasano%20Celiac%20other%20autoimmune%20disease.pdf Systemic Autoimmune disease and celiac

http://en.wikipedia.org/wiki/Anti-transglutaminase_antibodies EMA and transglutaminase antibodies

http://www.thyroid.org/patient-thyroid-information/ct-for-patients/vol-5-issue-6/vol-5-issue-6-p-3-4/ The effect of celiac disease on levothyroxine dosage

http://www.nature.com/cmi/journal/v8/n2/full/cmi201065a.html Antibodies in Celiac disease, implications beyond diagnosis

http://www.wjgnet.com/1007-9327/13/1715.asp Dutch study of patients with Hashimoto’s and Celiac disease

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2730948/ Celiac disease and autoimmunity in the gut and elsewhere

http://jeffreydachmd.com/2014/01/hashimotos-thyroid-disease-molecular-mimicry/

http://www.todaysdietitian.com/newarchives/110310p52.shtml Research connects Celiac and Hashimoto’s

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1808742/ Gliadin, TPO and other antibodies in latent autoimmune diabetes patients

https://www.enterolab.com/StaticPages/EarlyDiagnosis.aspx Before the Villi Are Gone

http://en.wikipedia.org/wiki/Human_leukocyte_antigen Define HLA

http://thyroidbook.com/eating-gluten-increases-need-thyroid-hormones/

http://www.hindawi.com/journals/ijad/2011/865432/ Transglutaminase enzyme involved in Alzheimer’s

http://www.csaceliacs.org/celiac_disease_defined.jsp

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2077662/ Hashimoto’s Encepheopathy and Cerebellar Ataxia

http://www.ncbi.nlm.nih.gov/pubmed/12566288 Gluten Ataxia

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3945755/ Glyphosate, pathways to modern disease: Celiac sprue and gluten intolerance

https://www.cyrexlabs.com/Portals/0/Docs/ClinicalApplications/ClinicalAppArray3.pdf

“Why Isn’t My Brain Working”, Dr. Datis Kharrazian, 2013 Elephant Press

In our previous post, we took a look at the relationship between Hashimoto’s and SIBO (small intestine bacterial overgrowth), if you have not yet read that or aren’t familiar with SIBO please read it here.

SIBO

SIBO, see part 1 for larger image

In this post we are going to discuss SIBO treatment and solutions. This information came from a lecture I attended in November 2014 taught by Dr. Datis Kharrazian and entitled The Neuroendocrine Immunology of Small Intestine Bacterial Overgrowth.

Treatment Depends on Where You Are in the Progression

One important lesson that I have learned after working with over 750 people with Hashimoto’s is that there are 2 things that are really important for getting good clinical results:

#1. Figure out the mechanism. In other words, where’s the problem? With Hashimoto’s it is often in multiple places and it’s not only the thyroid.

#2. Figure out how advanced it is. Hashimoto’s, like all autoimmune disease, is progressive. We have identified 3 stages of progression. (Read here to learn more ).

In a general sense, the further it has progressed the more you must do.

Healing By Subtraction

Another really valuable lesson I have learned is that, often, some of the most effective treatments and solutions come from subtraction.

Many common health problems are problems of excess. Too much sugar, too much stress, too much inflammation, too much salt, too many chemicals.

A simple and effective way of treating too much is by taking things away.

If you have insulin resistance or Type 2 diabetes, stop eating sugar and refined carbohydrates.

If stress is killing you, stop doing the things that cause you so much stress.

If you have too much inflammation, stop eating and behaving in a way that causes so much inflammation.

If your sick from too much salt, stop eating salt.

If pollution is killing us and our world, stop using so many chemicals.

Such a simple solution, so hard to actually do.

At first.

The reason is that we are conditioned to be consumers, not subtractors.

However, if you have Hashimoto’s, learning the habit of being content with less (sometimes a lot less) may just be the key to your healing.

Nowhere is this more true than in the treatment of SIBO

Diet Must Be the Foundation of Treatment

With SIBO, the foundation of treatment is diet because many of the bacteria feed on foods that are common in our diets.

And if you’re like a lot of people I’ve worked with you might be asking yourself, “Why not just wipe them out with antibiotics?”

According to the American Journal of Gastroenterology, recurrence of small intestine bacteria after antibiotics is quite high (the most commonly prescribed being Rifaximin).

Many people have to keep taking antibiotics over and over again for months with limited results.

And there is a tremendous cost to your immune system and to your future ability to defend yourself.

(There is no better way to be defeated by an enemy than to give him repeated opportunities to adapt to your weapons.)

The only thing that really works is to do the diet as a foundation and then use something to eradicate the bacteria along with it.

There are a number of herbs that are quite effective for this. Particularly those in the berberine family like goldenseal, coptis, etc.

Probiotics Can Also Be Beneficial

A pilot study by Spanish researchers found that probiotics worked better than pharmaceutical therapy for patients with chronic abdominal distention and SIBO.

“Based on this pilot study results, we can suggest that the probitoic herein (Lactobacillus casei, Lactobacillus plantarum, Streptococcus faecalis, Bifidobacterium brevis) used has a higher efficacy than metronidazonal in the early clinical response of patients with chronic abdominal distention and SIBO.”

The SIBO Diet

The SIBO diet is a terrific exercise in subtraction and should generally be done for a month or so to get the best results.

Since there are many foods that feed these bacteria, there are many foods that must be eliminated from your diet for this initial period of time.

Foods to Avoid:

Fructose: sugars, artificial sweeteners, corn syrup

Grains: rice, wheat, quinoa, millet, amaranth, and some non grains like tapioca

Legumes/Galactans: beans, peas, chickpeas, soybeans, lentils

Fructan-containing Vegetables: lettuce, onions, artichokes, beets, broccoli, cabbage, brussels sprouts, peas, asparagus, okra, shallots, mushrooms, green peppers, cauliflower

High-fructose fruits: grapes, apples, watermelon, cherries, kiwifruit, bananas, blueberries, mangos

Meat products: Breaded or processed meats such as hot dogs, bologna, potted meats, most cold cuts (added starches) and there are some who say to also avoid beef, pork and lamb.

Foods to Eat:

Nuts: All nuts except pistachios

Vegetables: All vegetables except those listed above

Low Fructose Fruits: apricots, avocados, cantaloupes, grapefruit, honeydew melons, nectarines, oranges, peaches, pineapples, raspberries, strawberries, tomatoes

Meats: chicken, fish, eggs, (and beef, lamb and pork in moderation)

Fats: Animal fat, oils

Steps of Treatment

The first step of treatment involves the diet as foundation and something to address the bacteria (like the herbs mentioned above).

Either during or after that Spartan menu, it is important to address the root causes and related issues of SIBO (read about these in Part I )

These problems include:

1. Too little stomach acid. Here’s the exception to the healing by subtraction rule. If you have too little stomach acid, you need more.

A simple treatment is to take things that boost stomach acid levels such as apple cider vinegar, lemon juice and ginger root.

Supplementing with Betain HCL may also be beneficial (consult your doctor for this).

2. An immune suppressed gut. Often the cause of this is too much corticosteroid treatment and/or too much cortisol from stress.

Here the subtraction rule works quite well. Stop the corticosteroids (unless you have a condition where you must take them) and do something about stress.

A great daily exercise in doing less? Silent seated meditation.

3. Injury to the gut nervous system (The Enteric Nervous System)

This type of neurodegeneration is permanent. However, this nervous system also has remarkable plasticity and a capacity to rewire itself.

There are couple of really important things to do here:

#1. Vigorous, (I mean really vigorous to the point of tears) gargling. Gargle with several glasses of water throughout the day.

This activates part of the nervous system connected to the vagus nerve which has a very strong connection to the gut.

#2. Stimulate your gag reflex. Order some wooden tongue depressors online and gently stimulate this reflex by pressing down on the tongue.

#3. Coffee enemas. Make sure the coffee isn’t too hot, and hold as long as possible. This causes nerve firing in the brain.

Start with a moderate amount and mild coffee, you can gradually increase both the amount of liquid and the strength of the coffee.

(Best to do it in the bathtub if you have one, so you are close to the toilet.)

How Long Do You Need to Treat SIBO?

Good question. You need to treat it for as long as it takes. And you may have to revisit this periodically. Generally speaking, the more severe it is, the longer and more committed you must be to healing it.

This may take several months.

It’s also true that the better you are at really following the diet and not cheating, the better the outcome and the faster your results.

Some Excellent New Supplements for SIBO

Apex Energetics has recently released 5 new SIBO products and we have started using them with promising results. Click here to purchase from our online store.

What’s exciting for me as a practitioner is that they have adapted some of the formulas we have already used with excellent results and given us another option for people who have complications.

Clearvite-GL

Clearvite-GL

 

Clearvite-GL: ClearVite-GL™ (K95) is based on Apex’s popular ClearVite™ formula and is designed to offer gastrointestinal and metabolic support.

This formula includes the powerful combination of hypoallergenic nutrients, amino acids, and minerals that other ClearVite™ products have, but excludes sources of rice and pea protein for those with sensitivities to grains or peas, or who require low carbohydrate content.

It also contains no sugars, which makes it ideal for anti-yeast diets. ClearVite-GL™ is also intended to support liver detoxication and chemical biotransformation with targeted nutritional cofactors.

Suggested use:  Mix 1 scoop with up to 4-6 ounces of water.  Mix well before drinking.  Use once a day, or as directed by your healthcare professional.

Repairvite SE

Repairvite SE

Repairvite SE: RepairVite-SE™ (K98) is based on Apex’s popular RepairVite™ formula and is intended to offer targeted intestinal support.

This product includes a limited amount of ingredients to offer support for those with certain dietary restrictions.

A high-quality, selective blend that includes brush border enzymes, L-glutamine, and zinc carnosine is incorporated to help support intestinal cell metabolism and the intestinal microbial environment.

Suggested use:  Mix 1 scoop with up to 4-6 ounces of water.   Mix well before drinking.  Use once a day, or as directed by your healthcare professional.

Sibotica

Sibotica

Sibotica: Sibotica™ (K97) incorporates key strains of probiotics that are intended to support the intestinal microbial environment, as well as the intestinal mucosal barrier.

This product may also help support the immune system via certain immune pathways. Key ingredients include Lactobacillus casei, Bifidobacterium breve, and Lactobacillus plantarum.

Suggested use: Take 1 capsule once a day, or as directed by your healthcare professional.

enzymixpro

Enzymixpro

EnzymixPro: EnzymixPro™ (K99) incorporates a special proprietary blend of various enzymes, including brush border enzymes, that has been designed to support the gastrointestinal system.

This formula combines a broad spectrum of enzymes to help support the digestion of sugars, starches, fibers, proteins, and fats.  It also includes HCl for further digestive support.

Proprietary Blend: 1372 mg of  Betaine HCI, Pepsin (porcine), Bromelain, Protease I, Protease II, Protease III, Protease IV, Glucoamylase, Cellulase, Sucrase (invertase), Maltase, Phytase, Pectinase, Lactase, Alpha-galactosidase, Lipase, Amylase I, Amylase II, Peptidase.

Suggested use:  Take 1-2 capsules once a day, or as directed by your healthcare professional.

enterovite

Enterovite

Enterovite: EnteroVite™ (K100) incorporates nutrients and a proprietary blend of fatty acids in a formulation intended to support the intestines and intestinal cell function.

This unique formulation is designed for those who are sensitive to certain food components, such as certain starches and fibers, and who want additional intestinal support.

Short-chain fatty acids (SCFAs), normal bacterial end products of complex carbohydrates, play important roles in intestinal microbial balance and function.

Diets that are low in resistant starch and fiber can result in a low production of SCFAs.  Key ingredients include butyric acid and calcium propionate.

Ingredients: Vitamin E (as d-alpha tocopherol acetate), Calcium (as calcium ß-hydroxy ß-methyl butyrate & calcium propionate) and a Propriety Blend: 575 mg* of  Butyric Acid (as calcium ß-hydroxy ß-methyl butyrate), Calcium Propionate.

Suggested use:  Take 1 capsule once a day, or as directed by your healthcare professional.

References:

orderapex.com

The Neuroendocrine Immunology of Small Intestine Bacterial Overgrowth, by Dr. Datis Kharrazian, DC, 2014

http://www.actagastro.org/actas/2010/n4/40_4_2010_7.pdf

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3610260/

Diet Matters with Hashimoto’s

For many people who struggle with Hashimoto’s, diet is a huge issue.

Yet, many doctors ignore the role of diet in the initiation, and progression of this and other autoimmune diseases.

But, if you have Hashimoto’s, and you are like a lot of people we’ve worked with, then you know that what you eat has a huge impact on your health and how you feel.

This just makes sense. Where is your immune system in your body?

Over 70% is found in and around your digestive tract. This is where it lives.

What you eat has a profound impact on autoimmune diseases like Hashimoto’s.

In this series of posts, we’ll examine a key factor in healing your Hashimoto’s by looking into something that is really common but often overlooked.

SIBO or small intestine bacterial overgrowth.

I recently attended a lecture taught by my teacher and mentor, Dr. Datis Kharrazian.

Dr. Kharrazian is a relentless researcher.

He is always exploring other people’s research and doing his own in order to help us understand why people are getting sick and how we can fix it.

In a recent lecture that I attended called “The Neuroendocrine Immunology of Small Intestine Bacterial Overgrowth”, he shared a lot of really valuable information on many aspects of SIBO that new research has revealed.

Why SIBO Matters to Someone with Hashimoto’s

Determining whether not you have SIBO can be really, really important for people with Hashimoto’s because of the role that the small intestines play in thyroid hormone conversion and absorption.

When you have Hashimoto’s and hypothyroidism this leads to problems with motor functions in the small intestine.

There are thyroid hormone receptors all over the gut. The vagus nerve fires into the gut.

If they aren’t getting enough thyroid hormone, things don’t move as well through there and that leads to overgrowth of bacteria.

And too much of this bacteria can interfere with levothyroxine absorption.

This is why some people take Synthroid, Armour, Cytomel, Naturethroid or another thyroid replacement hormone and it doesn’t feel like it’s working.

That’s because it isn’t.

With SIBO you can’t absorb thyroid hormone very well.

And autoimmunity shuts down T3 receptors.

Again, thyroid hormone doesn’t work if it can’t bind to receptors and can’t be absorbed.

So, even though you are taking thyroid hormone, it isn’t working – you have all the symptoms like fatigue, brain fog and memory issues, weight gain, hair loss, depression, etc.

The Small Intestine is Ground Zero for Autoimmunity

Many researchers also believe that autoimmune disease originates in the intestines.

A leaky gut or damaged intestine has been found in every autoimmune disease that has been tested including rheumatoid arthritis, ankylosing spondylitis, inflammatory bowel disease (Crohn’s disease and ulcerative colitis), celiac disease, multiple sclerosis, type I diabetes and, yes, Hashimoto’s.

In the small intestine this damage leads to immune system stimulation, the wrong types of things in the blood stream and, ultimately, a systemic problem that results in the loss of self-tolerance.

This means that the immune system gets so overwhelmed it can’t tell what is our tissue and what is a bad guy that must be attacked.

Which Came First Leaky Gut or SIBO?

There are many causes of the breakdown of the intestines.

These include NSAID use, alcohol, gluten and other dietary proteins, bacterial overgrowth, environmental toxins and more.

And once this breaks down it alters the whole ecosystem of the gut.

It’s hard to know which came first.

And at the end of the day, it doesn’t really matter.

What matters is what causes it and what we can do to heal it.

Symptoms of SIBO

SIBO has a number of possible symptoms, but mostly these involve bloating, gas, diarrhea and/or constipation.

The hallmark symptom is bloating and discomfort after eating certain foods.

Basically here’s what happens.

The wrong type of bacteria end up getting into the small intestine. The migrate from the large intestine and take over.

They feed on certain types of foods like sugars, galactans, fructans and starch.

In reality, SIBO should be considered with abdominal discomfort after eating any of the following things:

– Starches
– Sugars/fructose
– Fructans
– Prebiotics
– Probiotics
– Fiber supplements
– Rice or pea powder from metabolic powders
– Galactans

You may notice that many of the foods listed here can also aggravate candida. And sometimes candida is blamed for what is actually SIBO.

5 Main Causes of SIBO

The causes of SIBO matter because when we understand the causes, we can figure out how to fix them.

These include:

1. Too little stomach acid.

Hashimoto’s and hypothyroidism leads to lower production of gastrin and stomach acid. This is super common.

And ironically, many people develop GERD or acid reflux and are prescribed proton pump inhibitors and antacids that just make everything worse.

(We’ve discussed this in depth in this post)

2. An immune suppressed gut.

Many factors can lead to immune suppression in the gut. 2 important ones are long term corticosteroid treatment and chronic stress.

In either case, lots of cortisol or corticosteroids cause the immune system to shut down and allows the party to get out of control.

With Hashimoto’s the body is under a great deal of physiological stress, all the time. So extra emotional stress and abnormally stressful events often result in people getting a lot sicker.

This is one of the reasons why.

3. Injury to the gut nervous system (known as the ENS or enteric nervous system)

The gut has been called the body’s “second brain” because it has it’s own nervous system and produces many of the neurotransmitters that are also produced in the brain.

Well, just like our other brain this can degenerate and break down with age and with diseases like chronic celiac disease, sceleroderma and IBS.

And just like neurodegeneration in the brain, this can be permanent. But also, just like the brain this second brain has remarkable plasticity and it can relearn things and rewire itself, too.

The gut brain and our main brain are both loaded with thyroid hormone receptors. With Hashimoto’s and hypothyroidism, there is often too little thyroid hormone or it’s not getting absorbed properly.

This can result in damage to the enteric nervous system (the gut brain).

4. Problems with the Vagus nerve

The Vagus nerve is a central highway for communication between the brain and the gut. When the vagus nerve stops firing into the gut this slows down everything.

This is a major cause of slower motility and constipation.

Thyroid hormone has a direct affect on movement through the entire gastrointestinal tract.

Thyroid hormones increase intestinal neurotransmitters, increase blood flow to the intestines and support the repair and regeneration of the intestines.

Hypothyroidism can slow movement through the esophagus, can affect muscle function in this area and can affect the nerves that cause movement.

Hypothyroidism also has an affect on the vagus nerve and this can lead both directly and indirectly to slowing movement through the intestines.

5. Anatomical or structural changes to the small intestines or illeosecal valve

Surgery to the gut (like appendectomy or resection), diverticulitis and scarring due to inflammatory bowel disease can all lead to this.

Hypothyroidism can lead to the loss of control of the ileosecal valve that is the doorway between the large and small intestine.

When this stops working as it should it lets lots of critters from the large intestine into the small intestine.

SIBO Has Degrees of Severity

Just like Hashimoto’s, SIBO has different degrees of severity. These are important because the more serious it is the more work you may have to do to resolve it.

I. Asymptomatic:

Abnormal small intestine bacterial overgrowth tests and mild or no symptoms.

Bloating after meals.

II. Moderate Symptoms:

Bloating with malnutrition and constipation.

Bloating with nutritional deficiencies.

III. Severe Symptoms:

Bloating with anemia, low albumin, low cholesterol

Bloating with weight loss, chronic diarrhea and malabsorption

If you are a person who has trouble taking supplements because you just react to everything, then you may fall into the more severe symptoms category.

Who Has SIBO?

Here’s an overview from the Journal of Clinical Gastroenterology on the prevalence of SIBO in other conditions:

15% of the elderly

33% of people with chronic diarrhea

34% of people with chronic pancreatitis

53% of people using antacid medication

66% of patients with celiac disease with persistent symptoms.

78% of people with IBS

90% of alcoholics

What really stands out for me there are 2 of those statistics.

More than half the people on antacid medication and 9 out of 10 alcoholics suffer from SIBO.

That shows you how destructive alcohol can be to the small intestines.

And, the fact is that alcohol degenerates the enteric nervous system of the gut very aggressively.

How Do You Test for SIBO?

In the conventional medical model there are 2 types of testing for SIBO.

Both are flawed and not definitive.

1. Direct: Endoscopic Aspiration and Culture

This is a direct endoscopic aspiration and culture of the small intestine.

This requires a gastroenterologist, it’s expensive, it’s invasive (they have to go in and get a sample).

The problem with this is that many of the bacteria removed from the small intestine can’t be analyzed because they don’t survive in culture.

Samples must be handled properly for accurate results.

To recap: It’s expensive, it’s invasive and sometimes tests don’t reveal all the bacteria involved.

2. Indirect: Breath Testing for Hydrogen and Methane

This type of testing involves breath testing for hydrogen and methane.

This test can be inaccurate if someone has recently had antibiotics.

It may not be useful in determining all species of bacteria.

The optimal window for timing for collection is different for different people because transit time is different for different people.

To recap: You may get false negatives due to different transit times or antibiotic use.

Actually, the best test for SIBO is a trial diet and/or a stool test that looks for invasive species.

In our next post, we’ll look at this diet and how to treat all 5 different causes of SIBO and the various levels of seriousness.

References:

http://www.discoverymedicine.com/Kouki-Mori/2012/11/27/does-the-gut-microbiota-trigger-hashimotos-thyroiditis/

http://www.ncbi.nlm.nih.gov/pubmed/17698907 – SIBO and hypothyroidism -antibiotic therapy didn’t affect thyroid hormone levels

http://www.ijem.in/article.asp?issn=2230-8210;year=2014;volume=18;issue=3;spage=307;epage=309;aulast=Patil
Link between SIBO and hypothyroidism

http://journals.lww.com/theendocrinologist/abstract/1995/05000/absorption_of_oral_thyroxine.9.aspx

“It is markedly decreased in conditions in which there is a decrease in the effective small intestinal absorptive surface, including short bowel syndromes sprue, and other malabsorptive conditions.”

http://www.europeanreview.org/wp/wp-content/uploads/451-4561.pdf – Levothyroxine absorption in health and disease

http://gutcritters.com/thyroid-function-and-gastrointestinal-distress/ – LPS and thyroid receptors

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3099351/ SIBO Study

http://www.ncbi.nlm.nih.gov/pubmed/12388159?dopt=Abstract – Infection leads to poor thyroid hormone absorption

http://www.ncbi.nlm.nih.gov/pubmed/18372241 – LPS reduced T3

http://chriskresser.com/inflammation-strikes-again – Low T3 Syndrome

http://www.discoverymedicine.com/Kouki-Mori/2012/11/27/does-the-gut-microbiota-trigger-hashimotos-thyroiditis/

http://www.naturalendocrinesolutions.com/articles/sibo-thyroid-health/

http://neurosciencestuff.tumblr.com/post/38271759345/gut-instincts-the-secrets-of-your-second-brain Great article on the enteric nervous system

http://www.ncbi.nlm.nih.gov/pubmed/16336493 : glial cels in the gut cause neurodegeneration

http://www.jneuroinflammation.com/content/7/1/37 : neurodegeneration in IBD

http://ajpgi.physiology.org/content/ajpgi/303/8/G887.full.pdf : enteric glia cells are protective, damage to them leads to neurodegeneration

Prevalence of small intestine bacterial overgrowth diagnosed by quantitative culture of intestinal aspirate in celiac disease. J Clin Gastroenterol, 2009 Feb; 43 (2): 157-161

The Neuroendocrine Immunology of Small Intestine Bacterial Overgrowth, lecture notes, Dr. Datis Kharrazian, November 2014.

The Paleo Approach, Sarah Ballantyne, PhD, Victory Belt Publishing 2013

Vaccine - Preventive Medicine

Should You or Shouldn’t You?

Every year when flu season rolls around I get questions concerning whether or not to get a flu shot.

As with everything Hashimoto’s related, this is a seemingly simple question wrapped in a crazy complicated not-so-fast answer.

The Centers for Disease Control (CDC) recommends that everyone aged six years of age and older get a flu vaccine.

However, when you have Hashimoto’s you are not “everyone” and there are some unique challenges that need to be factored in first.

Some People with Hashimoto’s Get Wiped Out By the Flu Shot

In my experience in working with over 750 people with Hashimoto’s, I have found that some patients just get completed wiped out after getting the vaccine.

So, naturally, I have tried to figure out why. (‘Cause that’s how I roll.)

One person who has some great insight into this is infectious disease specialist Dr. Kent Holtorf, an MD I have a lot of respect for.

He’s a clinician and researcher and he operates outside of big pharma.

One thing he recommends is that people with mitochondrial dysfunction, chronic neurological illnesses, and fibromyalgia not get vaccinated because he has seen it “devastate” them.

I thought this was interesting because we have looked into the connection between fibromyalgia and Hashimoto’s (here’s a link if you missed that post) and these 2 patient populations have a lot in common.

So I would add Hashimoto’s patients to this list.

Because people with Hashimoto’s also have mitochondrial dysfunction, many have chronic neurological issues and more importantly, they also have an overzealous immune system.

Viruses and Hashimoto’s

And while viruses have not been definitively linked to the initiation of Hashimoto’s, upwards of 80% of the patients I have treated have been exposed to Epstein Barr virus somewhere in their history.

Of course, Epstein Barr (which is in the herpes family) and influenza virus are not the same.

However, the same part of the immune system is stimulated by the the influenza virus.

And if this is the part of the immune system that is over excited, then it stands to reason that bad things may happen if we make it mad.

It’s not nice to fool mother nature.

The Influenza B Virus and Hashimoto’s

In fact, there is also strong evidence that the Influenza B virus is also involved in the formation of Hashimoto’s, in some people.

So, what does that tell us?

That tells us that, for some people, the influenza vaccine (which is the exposure of dead fragments of the influenza virus to the immune system) may result in an aggressive immune response.

Which may result in a flare up of Hashimoto’s because this is also the part of the immune system that attacks the thyroid.

And for some of those people, that flare up may be “devastating”. I have seen this happen in my patients and this is precisely what Dr. Holthorf is describing, as well.

And these effects can be severe and long lasting because they may fire up the process that led to Hashimoto’s in the first place.

Of course this is not true of everyone. Some people with Hashimoto’s can tolerate the vaccine and do just fine.

Should You Get a Flu Shot?

Like so many things with Hashimoto’s, there is no simple yes or no answer.

If you are among the group that is triggered by viruses, then you run the risk of igniting the fire that already burnt you.

Another question is, what is your risk of exposure?

If you mostly stay home or work from home and have limited contact with other people, your risk of exposure to the flu will be small.

On the other hand, if you have school aged children who love to share every germ and virus imaginable, then your risk is considerably higher.

Also, there’s the question of whether or not you have other serious health conditions, in addition to Hashimoto’s.

If you have a serious chronic illness like emphysema, diabetes or heart disease, catching the flu could have life-threatening consequences for you.

You’ll have to weigh the risks of getting the vaccine and triggering a Hashimoto’s flare up against the potentially serious complications from catching the flu.

Generally, if you’ve had a flu shot in the past and didn’t have an adverse reaction, then you’re probably ok to have another.

Another thing to be aware of is that it’s kind of a crap shoot with the flu vaccine because the manufacturers simply make an educated guess about which strain will be prevalent next year.

And they are not always right.

What Can You Do If You Can’t Get the Vaccine?

What about those of us who don’t want to play with mother nature, but also don’t want to get the flu?

Fortunately, there are some really excellent natural solutions for this.

These include herbs and essential oils that have broad spectrum anti-viral properties and can help protect against both the cold and the flu.

Chinese Medicine to The Rescue

Chinese medicine has a wide variety of broad spectrum anti-bacterial and anti-viral herbs that have been used for centuries to treat many infectious diseases.

In fact, there are whole schools of Chinese medical thought that are based on some very famous texts that taught early Chinese doctors how to treat infectious diseases.

2 of the most famous are The Shan Han Lun  or On Cold Damage by Zhang Zhong Jing (thought by many to be the Hippocrates of Chinese Medicine) and Wen Bing Xue or Warm Disease Theory authored by five medical geniuses of the Qing Dynasty.

These texts were (and still are) the clinical manuals for generations of doctors who had to treat epidemics long before the advent of vaccines.

And they have saved countless lives.

Which Herbs Can You Use?

Let’s take a look at some effective herbs that you can use both to protect you from the flu and to treat it if you get it.

And I’ll also show you where you can get an excellent herbal formula that has these herbs in it.

Ban lan gen (Isatis indigtica root): Ban lan gen has broad spectrum anti-bacterial effects and has shown to be effective against influenza viruses.

Ye ju hua (Chrysanthemum indicum flower): Has both anti-viral and antibacterial properties. In one study, 501 patients were treated with good results.

Jin yin hua (Honeysuckle flowers): Very effective in treating colds and influenza. Broad spectrum antibiotic effects. In one study involving 393 children an herbal formula made with an herbal inhalant showed marked preventative effects.

Gang mei gen (Ilex asperella root): An effective herb for treating cough and lung issues.

There is an excellent herbal formula that I take whenever I travel or am around sick people and which I prescribe to my patients called Gan Mao Ling.

This formulation has all these herbs and a couple of others in it and it is available at this website: Click here to check it out!

Take 6-8 tablets prior to being around people who may be sick and 3-6 tablets 3-4 times a day if you feel like you are coming down with the flu.

Often this is preceded by a scratchy throat and congestion.

Essential Oil Inhalers:

Another way to protect yourself is to use an inhaler that has essential oils with anti-viral properties.

This is excellent for children and for traveling, as you can carry it with you and just take a quick inhale when you need it or fear that you may have had some exposure.

The influenza virus is air borne, so you can attack it where it lives.

Ravensarra is an excellent oil that is known for it’s broad spectrum anti-viral  and anti-bacterial properties. It is also great for asthma because it is anti-spasmodic and it’s an expectorant (helps clear out phlegm).

Mentha piperita or peppermint is also an excellent oil which is anti-microbial, analgesic, anti-infectious, it has broad spectrum anti-bacterial properties, and it’s great for clearing out mucous. It’s also very beneficial for your brain.

Eucalyptus oil is a great decongestant, aids breathing by opening up your airways.

Picea mariana or black spruce is anti-spasmodic, helps clear out mucous and is broad spectrum anti-fungal, anti-bacterial and anti-viral. and it’s a great anti-inflammatory!

Here’s a wonderful inhaler that has all these oils in it: Click here to check it out!

It’s great as a preventative and for clearing your sinuses when you have a cold or flu. I love using these when I travel, especially on a plane where you bound to get exposed to something.

You can take this as often as you need to. It’s pretty potent, a little goes a long way!

Those are 2 excellent solutions to the flu and they are quite effective.

The key is to take them before you have been exposed or as early as possible when you feel it coming on.

References:

http://www.healthcentral.com/chronic-pain/c/5949/145399/fibromyalgia/

http://www.ncbi.nlm.nih.gov/pubmed/12428064

http://www.thyroid-info.com/hashimotos-encephalopathy.htm

http://www.ncbi.nlm.nih.gov/pubmed/18240111

http://www.ncbi.nlm.nih.gov/pubmed/20625285

http://www.discoverymedicine.com/Kazuki-Morohoshi/2011/12/20/viral-infection-and-innate-pattern-recognition-receptors-in-induction-of-hashimotos-thyroiditis/

http://www.ncbi.nlm.nih.gov/pubmed/18788945?dopt=Abstract&holding=f1000,f1000m,isrctn

http://www.virologyj.com/content/6/1/5#B104

Chinese Medical Herbology and Pharmaclogy, John and Tina Chen, 2001

The Aromatherapy Practitioner reference Manual, Sylla Sheppard-Hanger 1994

Red Fox

Think Like A Fox

Hedgehog

Not Like A Hedgehog


I recently read a book called the Signal and the Noise by Nate Silver.

It’s an in depth look at how to use data and other information to make better predictions.

What does that have to do with Hashimoto’s?

Well, Hashimoto’s is very complex and there is an extraordinary amount of noise, that is information and advice that may or may not be helpful.

And as someone who is trying to solve problems and help others with this complex problem, I thought that learning how to better interpret the data and the information might give all of us some clues about how to get better results.

Ultimately, solving this problem requires that you be a detective and to be a good detective you have to look at the available information and be able to make predictions about whether or not what you are going to do will work.

Because if you are wrong, there are consequences.

And sometimes those consequences can result in you feeling a whole lot worse.

And pushing this thing in the wrong direction.

Our recent look at people’s experience with iodine is a perfect example of this (see our last post).

In the book there is a reference to a professor of psychology and political science named Philip Tetlock.

He identifies 2 distinct types of writers and thinkers: Foxes and Hedgehogs.

Hedgehogs are type A personalities who believe in Big Ideas – in governing principles about the world that behave as though they were physical laws and they are the foundation of everything.

Like Karl Marx and class struggle or Sigmund Freud and the subconscious. Or many MDs and Synthroid.

Foxes, on the other hand are scrappy creatures who believe in lots of little ideas and in taking a multitude of approaches toward a problem.

They tend to be more tolerant of nuance, uncertainty, complexity, and dissenting opinion.

If hedgehogs are looking for that one big meal, while foxes are gatherers.

Well, it turns out that foxes are a lot better at making accurate predictions.

And better predictions usually means better results.

So, to get better results with your Hashimoto’s, think like a fox.

How Foxes think:

They are multidisciplinary: They incorporate ideas from different places regardless of their origin on the ideological spectrum.

(Both doctors and alternative care practitioners are right about some things and wrong about others. Evaluate the message regardless of the messenger.)

They are adaptable: They find a new approach – or pursue multiple approaches at the same time – if they aren’t sure the original one is working.

(If lab tests show your TSH and antibodies going up as a result of a treatment, this is not necessarily a good thing. No matter how it is rationalized or justified.)

They are self-critical: They are sometimes willing (if rarely happy) to acknowledge their mistakes and accept responsibility for them. (Can your doctor admit when he or she is wrong or stumped?)

They are tolerant of complexity: They see the universe as complicated, perhaps to the point of seeing many problems being unpredictable.

(Hashimoto’s is the very definition of complexity.)

They are cautious: They express their predictions in terms of what will probably happen and qualify their opinions.

(There are no absolutely certain outcomes.)

They are empirical: They rely on observation and real data rather than theory.

(They use what exists, not what they want it to be or what will sell more of the products they created or endorse.)

Foxes are better forecasters and, therefore, get better results.

How Hedgehogs think:

They focus on one or 2 things that are the answer or the solution. They may view the opinions of “outsiders” skeptically.

(Synthroid is the only answer.)

They are stalwart: they stick to the same “all-in” approach – new data is used to refine their original model. To confirm their bias.

(See? You didn’t do well on Armour, Synthroid is the only answer.)

They are stubborn: Mistakes or bad decisions are blamed on bad luck or weird circumstances – a good theory had a bad day.

(Removing the thyroid removes the disease. And Synthroid is the only answer, you just need to increase the dosage.)

They are order seeking: They expect that the world will be found to follow a relatively simple set of rules.

(It’s just a thyroid problem. Synthroid is the only answer.)

They are confident: They rarely hedge their predictions and are reluctant to change them.

(You read too much on the internet. Synthroid is the only answer.)

They are ideological: The expect that solutions to many problems are manifestations of some grander theory or struggle.

(Sythroid is the only answer. It was the #1 prescribed drug in the US in 2013. I rest my case.)

Hedgehogs are weaker forecasters and, therefore, don’t get great results.

Here are 3 broad principles to be more fox-like:

1. Think probabilistically. In other words, think about a range of possible outcomes. Don’t make broad assumptions.

For example, take the theory that everyone needs more T3. Reality is more nuanced: Some people need more T3, others don’t and some people get worse with the addition of T3.

The same is obviously true of iodine and a number of other things. You may fall anywhere on that continuum. Find out what is true for you.

2. When the facts change, change your mind.

There’s nothing worse than stubbornly holding onto a belief that has been proven to be untrue.

This is why I’m opposed to protocols. They force you into a pre-existing solution.

There are so many variables, so many moving parts.

Let the facts on the ground dictate your approach.

3. Look for consensus.

Time and experience generally has a way of revealing the truth.

Sometimes there are big innovations, but these events are pretty rare.

Lastly, beware of magic bullet solutions.

With Hashimoto’s, after working with and talking to hundreds of people with this disease, I can tell you that there is nothing that works for everyone.

NOTHING.

You just need to learn to be like a fox and accept that.

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